From the Guidelines
Clindamycin is the preferred choice for the treatment of necrotizing fasciitis caused by group A streptococci, while zosyn (piperacillin/tazobactam) can be used as part of empiric treatment for polymicrobial necrotizing fasciitis.
Key Considerations
- The treatment of necrotizing fasciitis should include surgical intervention as the primary therapeutic modality, with antimicrobial therapy playing a supportive role 1.
- For group A streptococcal necrotizing fasciitis, the recommended treatment is penicillin plus clindamycin 1.
- For polymicrobial necrotizing fasciitis, empiric treatment should include agents effective against both aerobes and anaerobes, such as vancomycin or linezolid plus piperacillin-tazobactam or a carbapenem 1.
- Clindamycin is useful for coverage of anaerobes and aerobic gram-positive cocci, including most S. aureus serogroups 1.
- Piperacillin-tazobactam is useful for coverage against resistant gram-negative rods 1.
Treatment Options
- Clindamycin:
- Dose: not specified in the guidelines
- Indication: group A streptococcal necrotizing fasciitis
- Zosyn (piperacillin/tazobactam):
- Dose: not specified in the guidelines
- Indication: polymicrobial necrotizing fasciitis, as part of empiric treatment
Important Notes
- The choice of antibiotic should be guided by the suspected or confirmed microbial etiology of the infection 1.
- Antimicrobial 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.
From the Research
Treatment Options for Necrotizing Fasciitis
- The treatment of necrotizing fasciitis requires a multifaceted approach, consisting of surgical source control with immediate surgical debridement along with life support, clinical monitoring, and antimicrobial therapy 2.
- Broad-spectrum coverage is advisable, and acceptable monotherapy regimens include piperacillin-tazobactam or a carbapenem 2.
- Clindamycin can be used in combination with other antibiotics, such as metronidazole, as an alternative to non-betalactam anti-MRSA agents for necrotizing fasciitis management 2.
Antibiotic Prescriptions for Necrotizing Fasciitis
- The top three empirical antibiotics prescribed for necrotizing fasciitis are ampicillin + sulbactam, clindamycin, and ceftazidime 3.
- The selection of the antibiotic significantly impacts the outcome of necrotizing fasciitis, and broad-spectrum empirical antibiotics following surgical debridement reduce the mortality rate of NF 3.
- Clindamycin is recommended as part of the initial calculated antibiotic treatment, in combination with aminopenicillin ± sulbactam and/or metronidazole 4.
Effectiveness of Clindamycin and Piperacillin/Tazobactam
- Clindamycin has been shown to be effective in treating necrotizing fasciitis, particularly in combination with other antibiotics 4, 5.
- Piperacillin/tazobactam is a recommended monotherapy regimen for necrotizing fasciitis, providing broad-spectrum coverage 2.
- The use of clindamycin or piperacillin/tazobactam as part of the treatment regimen for necrotizing fasciitis can improve patient outcomes, including reducing the risk of amputation and mortality 3, 4.