From the Guidelines
Gangrene in travelers requires immediate medical attention at the nearest hospital or emergency facility, with treatment involving aggressive surgical debridement and broad-spectrum antibiotics, such as piperacillin-tazobactam or meropenem, as soon as possible 1.
Treatment Approach
The primary goal is to remove all dead tissue and prevent the spread of infection.
- Aggressive surgical debridement is essential to improve survival and reduce the number of surgical revisions 1.
- Broad-spectrum antibiotics, such as piperacillin-tazobactam, meropenem, or a combination of clindamycin and ciprofloxacin, should be started empirically as soon as the diagnosis is suspected 1.
- In severe cases, amputation may be necessary to prevent the spread of infection.
Antibiotic Regimen
The choice of antibiotics should cover gram-positive, gram-negative, aerobic, and anaerobic bacteria, as well as an anti-MRSA agent 1.
- Examples of recommended antibiotics include piperacillin-tazobactam, meropenem, or a combination of clindamycin and ciprofloxacin.
Adjunctive Treatments
Hyperbaric oxygen therapy may be used as an adjunctive treatment to improve tissue oxygenation and enhance antibiotic effectiveness, although its benefit is still controversial 1.
Prevention
Prevention includes proper wound care, maintaining good hygiene, and managing underlying conditions like diabetes while traveling.
Underlying Cause
The underlying cause, such as diabetes, vascular disease, or frostbite, must also be addressed to prevent further complications. Prompt medical attention is crucial, as gangrene can progress rapidly and be life-threatening 1.
From the Research
Treatment for Gangrene in Travelers
The treatment for gangrene, particularly in travelers, involves a combination of surgical debridement, antibiotic therapy, and hyperbaric oxygen treatment.
- Surgical debridement is essential to remove necrotic tissue and prevent the spread of infection 2, 3, 4.
- Antibiotic therapy is crucial to treat the underlying infection, and broad-spectrum antibiotics are often used to cover both aerobic and anaerobic bacteria 2, 3, 5.
- Hyperbaric oxygen therapy has been shown to be an effective adjunctive treatment for gangrene, as it increases tissue oxygenation, reduces systemic toxicity, and prevents the extension of necrotizing infection 3, 4, 6.
Specific Considerations for Travelers
Travelers with gangrene may require additional considerations, such as:
- Prompt medical attention to prevent delays in treatment 3, 4.
- Management of underlying conditions, such as diabetes mellitus, which can increase the risk of gangrene 2, 5.
- Adaptation of therapy to the patient's individual needs, such as obesity or other comorbidities 5.
Hyperbaric Oxygen Therapy
Hyperbaric oxygen therapy has been shown to be a valuable adjunctive treatment for gangrene, with benefits including: