What is the treatment for Necrotizing Fasciitis (nec fac)?

From the Guidelines

Necrotizing fasciitis (NEC FAC) requires immediate aggressive treatment with a multidisciplinary approach, prioritizing urgent surgical debridement of all infected tissue and broad-spectrum intravenous antibiotics, such as a combination of piperacillin-tazobactam, vancomycin, and clindamycin, to cover gram-positive, gram-negative, and anaerobic organisms, as recommended by the 2018 WSES/SIS-E consensus conference 1. The cornerstone of treatment is urgent surgical debridement of all infected tissue, which may need to be repeated multiple times until all necrotic tissue is removed. This is combined with broad-spectrum intravenous antibiotics, typically starting with a combination of piperacillin-tazobactam (4.5g IV every 6-8 hours), vancomycin (15-20 mg/kg IV every 8-12 hours), and clindamycin (600-900 mg IV every 8 hours) to cover gram-positive, gram-negative, and anaerobic organisms, as suggested by the practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America 1. Some key points to consider in the treatment of NEC FAC include:

• Urgent surgical consultation is recommended 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 gram-positive, gram-negative, and anaerobic organisms, until culture-specific results and sensitivities are available 1
• The use of antimicrobial therapy is an adjuvant treatment and must be combined with early surgical debridement, with the goal of administering antibiotics until further debridement is no longer necessary, the patient has improved clinically, and fever has been resolved for 48–72 h 1
• Procalcitonin monitoring may be useful to guide antimicrobial discontinuation, as suggested by several controlled clinical studies 1
• Supportive care is essential, including fluid resuscitation, pain management, and possibly intensive care for hemodynamic support, with early involvement of infectious disease specialists, surgeons, and critical care teams improving outcomes 1

From the Research

Treatment for Necrotizing Fasciitis

The treatment for necrotizing fasciitis (NF) typically involves a combination of:

• Surgical debridement: removal of dead tissue to prevent further infection and promote healing 2, 3, 4, 5, 6
• Antibiotics: broad-spectrum antibiotics to treat the underlying infection 2, 3, 4, 5, 6
• Hyperbaric oxygen therapy: to improve oxygenation of the infected tissues and promote healing 2, 4
• Negative pressure wound therapy: to improve wound bed preparation and healing 4, 6
• Nutritional support: to support the patient's overall health and recovery 3, 5

Key Considerations

• Early diagnosis and treatment are critical to improving outcomes and reducing mortality 2, 3, 4, 5, 6
• Radical surgical debridement is often necessary to remove all infected tissue 3, 4, 5
• Repeated surgical debridement may be necessary to ensure complete removal of infected tissue 5
• Laboratory tests, such as the LRINEC score, can help diagnose and assess the severity of NF 5