From the Guidelines
Necrotizing fasciitis should be treated with empiric antibiotics that cover both aerobes and anaerobes, such as vancomycin or linezolid combined with piperacillin-tazobactam or a carbapenem.
Recommended Antibiotics
- Vancomycin or linezolid for coverage of MRSA and other gram-positive organisms
- Piperacillin-tazobactam or a carbapenem (imipenem-cilastatin, meropenem, and ertapenem) for coverage of gram-negative organisms and anaerobes
- Ceftriaxone plus metronidazole as an alternative option
- Clindamycin and penicillin for necrotizing fasciitis caused by group A streptococci, as clindamycin suppresses streptococcal toxin and cytokine production 1
Key Considerations
- Surgical intervention is the primary therapeutic modality in cases of necrotizing fasciitis, and antibiotics should be used as an adjunct to surgery 1
- Antibiotic therapy should be continued until further debridement is no longer necessary, the patient has improved clinically, and fever has been absent for 48-72 hours 1
- The choice of antibiotics may need to be modified based on the results of microbiological tests and the patient's clinical response to treatment 1
From the Research
Recommended Antibiotics for Treating Necrotizing Fasciitis
The following antibiotics are recommended for treating necrotizing fasciitis:
- Ampicillin + sulbactam 2
- Clindamycin 2, 3, 4
- Ceftazidime 2
- Aminopenicillin ± sulbactam in combination with clindamycin and/or metronidazole 4
Rationale for Antibiotic Selection
The selection of antibiotics is based on the common causative pathogens of necrotizing fasciitis, which include:
- Streptococcus spp. 2
- Pseudomonas aeruginosa 2
- Staphylococcus spp. 2 The use of broad-spectrum empirical antibiotics, such as ampicillin + sulbactam and clindamycin, has been shown to reduce the risk of amputation and improve prognosis 2, 3.
Importance of Early Treatment
Early diagnosis and treatment of necrotizing fasciitis are crucial to prevent mortality and morbidity 5, 6, 4. Surgical debridement and antibiotic therapy should be initiated promptly to reduce the risk of amputation and improve outcomes 2, 4.