What is the treatment for Necrotizing Fasciitis in pediatric patients?

From the Guidelines

Treatment for Necrotizing Fasciitis in Pediatric Patients

The treatment for Necrotizing Fasciitis in pediatric patients typically involves prompt surgical debridement and broad-spectrum antibiotics 1. This approach is necessary due to the rapid progression of the disease, which can lead to significant morbidity and mortality if left untreated.

Surgical Debridement

• Surgical intervention is the primary therapeutic modality in cases of necrotizing fasciitis and is indicated when this infection is confirmed or suspected 1.
• Most patients with necrotizing fasciitis should return to the operating room 24–36 hours after the first debridement and daily thereafter until the surgical team finds no further need for debridement 1.
• Aggressive fluid administration is a necessary adjunct to surgical debridement 1.

Broad-Spectrum Antibiotics

• Empiric treatment of polymicrobial necrotizing fasciitis should include agents effective against both aerobes, including MRSA, and anaerobes 1.
• Recommended antibiotic regimens include:
  • Vancomycin combined with one of the following options:
    • Piperacillin-tazobactam
    • A carbapenem (imipenem-cilastatin, meropenem, and ertapenem)
    • Ceftriaxone plus metronidazole
    • A fluoroquinolone plus metronidazole 1
  • Clindamycin and penicillin for necrotizing fasciitis and/or streptococcal toxic shock syndrome caused by group A streptococci 1
• Antibiotics should be administered until further debridement is no longer necessary, the patient has improved clinically, and fever has been absent for 48–72 hours 1.

Supportive Care

• Fluid resuscitation and pain management are crucial in managing the condition and promoting recovery.
• Intravenous immunoglobulin (IVIG) may be considered in some cases, but its efficacy in treating streptococcal toxic shock syndrome has not been established 1.

It is essential to note that delayed surgical intervention (more than 12 hours) is associated with higher mortality, and antibiotics should be given as soon as possible, ideally within the first 6 hours 1. The duration of antibiotic treatment can be between 7–14 days 1.

From the Research

Treatment Overview

The treatment for Necrotizing Fasciitis in pediatric patients typically involves a combination of:

• Antibiotic administration 2, 3, 4, 5
• Surgical debridement of necrotic tissue 2, 3, 4, 5
• Wound management techniques, such as Negative Pressure Wound Therapy (NPWT) and Vacuum-Assisted Closure (VAC) 3
• Application of extracellular matrix (ECM) graft placement 3
• Hyperbaric oxygen and immunoglobulin therapy may also be used in some cases 2

Conservative Management

Conservative management of Necrotizing Fasciitis in children has been shown to be effective, with minimal morbidity and mortality 4. This approach involves:

• Aggressive fluid resuscitation
• Analgesia
• Broad-spectrum antibiotics
• Dressing with povidone iodine ointment
• Removal of dead tissue with forceps on the ward
• Wound washing with liberal quantities of water

Surgical Management

Surgical debridement is often necessary to remove necrotic tissue and promote wound healing 2, 3, 5. In some cases, repeated surgical debridement may be required 2.

Wound Closure

Wound closure techniques, such as NPWT and ECM graft placement, can be effective in managing the residual skin and soft tissue deficit after surgical debridement 3.

Delays in Diagnosis and Management

Delays in diagnosis and management of Necrotizing Fasciitis in pediatric patients can occur, highlighting the need for prompt and appropriate treatment 5. The lack of a standardized approach to the pediatric patient with suspected NF can result in delays in management and suboptimal antibiotic choice 5.