From the Guidelines
The recommended treatment for pediatric patients with necrotizing fasciitis requires immediate aggressive surgical debridement combined with broad-spectrum intravenous antibiotics, as outlined in the 2014 update by the Infectious Diseases Society of America 1.
Treatment Overview
The treatment approach should include:
- Immediate surgical intervention to remove all necrotic tissue, which may require multiple debridements
- Broad-spectrum intravenous antibiotics to cover Group A Streptococcus, Staphylococcus aureus (including MRSA), and gram-negative organisms
- Supportive care in a pediatric intensive care unit, including fluid resuscitation, pain management, and possibly inotropic support for hemodynamic stability
Antibiotic Therapy
Initial empiric antibiotic therapy should include:
- Vancomycin (15 mg/kg IV every 6 hours)
- Piperacillin-tazobactam (100 mg/kg IV every 6-8 hours)
- Clindamycin (10 mg/kg IV every 6-8 hours) Antibiotic therapy should be adjusted based on culture results and continued for at least 2-3 weeks, or until clinical improvement is evident and no further surgical debridement is needed 1.
Surgical Intervention
Surgical intervention should occur as soon as possible, with complete removal of all necrotic tissue. Most patients with necrotizing fasciitis should return to the operating room 24–36 hours after the first debridement and daily thereafter until the surgical team finds no further need for debridement 1.
Adjunctive Treatment
Hyperbaric oxygen therapy may be considered as an adjunctive treatment in certain cases. However, the efficacy of intravenous immunoglobulin (IVIG) in treating streptococcal toxic shock syndrome has not been established 1.
Treatment Summary
The following table summarizes the recommended treatment for pediatric patients with necrotizing fasciitis:
| Treatment | Recommendation |
|---|---|
| Surgical Debridement | Immediate and aggressive, with multiple debridements as needed |
| Antibiotic Therapy | Vancomycin, piperacillin-tazobactam, and clindamycin, adjusted based on culture results |
| Supportive Care | Fluid resuscitation, pain management, and possibly inotropic support in a pediatric intensive care unit |
| Adjunctive Treatment | Hyperbaric oxygen therapy may be considered, but IVIG is not recommended |
From the Research
Treatment of Necrotizing Fasciitis in Pediatrics
The treatment of necrotizing fasciitis in pediatric patients typically involves a combination of surgical debridement, antibiotic therapy, and supportive care. The following table summarizes the recommended treatment approaches:
| Treatment Approach | Description |
|---|---|
| Surgical Debridement | Extensive surgical debridement to remove necrotic tissue and prevent further spread of the infection [2,3,4] |
| Antibiotic Therapy | Administration of broad-spectrum antibiotics, such as penicillin, an aminoglycoside, and metronidazole, with subsequent adjustments based on culture data [2,4] |
| Supportive Care | Intensive supportive care, including management of septic shock, pain control, and wound care [2,3,4] |
| Wound Closure Techniques | Use of negative pressure wound therapy (NPWT) and vacuum-assisted closure (VAC) to promote wound healing and closure [3] |
| Extracellular Matrix (ECM) Graft Placement | Application of ECM grafts to promote wound healing and tissue regeneration [3] |
Key Considerations
- Early recognition and diagnosis of necrotizing fasciitis are crucial to reduce morbidity and mortality 2, 4, 5
- Aggressive surgical debridement and antibiotic therapy are essential components of treatment 2, 4, 5
- Supportive care, including management of septic shock and pain control, is critical to patient outcomes 2, 3, 4
- Wound closure techniques, such as NPWT and ECM graft placement, can promote wound healing and tissue regeneration 3