From the Guidelines
The treatment approach for necrotizing fasciitis requires immediate aggressive surgical debridement combined with broad-spectrum antibiotics, as recommended by the Infectious Diseases Society of America in 2014 1. The primary goal of treatment is to reduce morbidity, mortality, and improve quality of life by promptly addressing the infection and preventing further tissue damage.
- Key considerations in the treatment approach include:
- Prompt surgical consultation for patients with aggressive infections associated with signs of systemic toxicity or suspicion of necrotizing fasciitis or gas gangrene 1
- Empiric antibiotic treatment should be broad, covering both aerobes and anaerobes, with options including vancomycin or linezolid plus piperacillin-tazobactam or a carbapenem, or plus ceftriaxone and metronidazole 1
- Penicillin plus clindamycin is recommended for treatment of documented group A streptococcal necrotizing fasciitis, as clindamycin inhibits toxin production and has been shown to be superior to penicillin in animal models and observational studies 1
- Initial empiric antibiotic therapy should include coverage for gram-positive, gram-negative, and anaerobic organisms, typically with a combination of piperacillin-tazobactam or meropenem, plus vancomycin, and clindamycin 1
- Hemodynamic support with IV fluids and vasopressors is often required, along with intensive care monitoring, and nutritional support should be initiated early, often requiring 25-35 kcal/kg/day 1 The high mortality rate associated with necrotizing fasciitis, up to 30%, underscores the need for rapid diagnosis and aggressive intervention to reduce morbidity, mortality, and improve quality of life 1.
From the Research
Treatment Approach for Necrotizing Fasciitis
The treatment approach for necrotizing fasciitis involves a combination of surgical and medical interventions. The primary treatment is surgery, which includes wide, extensive debridement of all tissues that can be easily elevated off the fascia with gentle pressure 2. This is often complemented by antibiotics to manage the infection.
Key Components of Treatment
- Surgical debridement: Radical surgical debridement is the priority in every case of necrotizing fasciitis 3.
- Antibiotic therapy: Broad-spectrum antibiotics are used to manage the infection, which is often polymicrobial 2, 4.
- Supportive care: This includes fluid and electrolyte management, and analgesia to manage pain and prevent complications 5.
- Adjunctive therapies: Hyperbaric oxygen therapy, intravenous immunoglobulin, and clindamycin may be used as adjunctive therapies, although their efficacy has not been rigorously established 2, 5, 6.
Importance of Early Treatment
Early and aggressive surgical therapy, including debridement and drainage, is crucial for complete recovery from necrotizing fasciitis 6, 4. Delayed treatment can lead to increased mortality rates, which can be as high as 76% in some cases 6. Therefore, a high index of suspicion for the diagnosis and prompt treatment are essential to improve outcomes.