What is the treatment for necrotizing fasciitis of the penile shaft?

From the Guidelines

Necrotizing fasciitis of the penile shaft requires immediate aggressive treatment with a combination of surgical debridement and broad-spectrum antibiotics, prioritizing prompt surgical consultation for patients with signs of systemic toxicity or suspicion of necrotizing fasciitis 1. The treatment approach should involve urgent surgical intervention to remove all infected and necrotic tissue, which may need to be performed in multiple stages.

• The antibiotic regimen typically includes a combination of broad-spectrum antibiotics, such as vancomycin or linezolid plus piperacillin-tazobactam or a carbapenem, to cover polymicrobial or monomicrobial etiologies, including group A streptococci and community-acquired MRSA 1.
• The choice of antibiotics may be adjusted based on culture results, which should be obtained during debridement, and consideration should be given to using penicillin plus clindamycin for documented group A streptococcal necrotizing fasciitis 1. Key considerations in the management of necrotizing fasciitis of the penile shaft include:
• Hemodynamic support with IV fluids and vasopressors for patients with septic shock
• Close monitoring in an intensive care setting
• Potential use of hyperbaric oxygen therapy as an adjunctive treatment in some cases
• The need for reconstructive surgery following the acute phase to address tissue defects Given the significant mortality rate and potential for substantial tissue loss associated with penile necrotizing fasciitis, early recognition and immediate treatment are crucial for survival and to preserve penile tissue and function.

From the Research

Treatment for Necrotizing Fasciitis of the Penile Shaft

The treatment for necrotizing fasciitis of the penile shaft involves a multifaceted approach, including:

• Surgical source control with immediate surgical debridement 2, 3
• Life support and clinical monitoring 2, 4
• Antimicrobial therapy with broad-spectrum coverage 2, 3, 5
• Supportive treatment, such as fluid resuscitation, assistant ventilation, and vasoactive drugs 4

Surgical Management

Surgical therapy is indicated if necrotizing fasciitis is suspected, and may involve:

• Immediate aggressive surgical management 2
• Extended debridement 2
• Early amputations of the affected tissues in some cases 2

Antimicrobial Therapy

Acceptable monotherapy regimens for necrotizing fasciitis include:

• Piperacillin-tazobactam or a carbapenem 3
• Clindamycin, which can affect Group A Streptococcus virulence factors and improve clinical outcome 5
• New cephalosporins active against methicillin-resistant Staphylococcus aureus (MRSA), such as ceftaroline and ceftobiprole 3
• Long-acting lypoglycopeptides, such as oritavancin and dalbavancin, which are effective in treating necrotizing fasciitis and suitable for patients requiring short hospital stays and early discharge 3

Risk Factors for Mortality

Several risk factors can increase the mortality rate in patients with necrotizing fasciitis, including:

• Being female, age >60, or having chronic heart disease, cirrhosis, or skin necrosis 6
• Pulse rate >130/min, systolic BP <90 mmHg, or serum creatinine ≥1.6 mg/dL 6 Close monitoring and early treatment are crucial to reduce morbidity and mortality in patients with these risk factors.