From the Guidelines
Necrotizing fasciitis in pediatrics should be treated with prompt surgical intervention and broad-spectrum antibiotics.
Treatment Overview
- Surgical intervention is the primary therapeutic modality in cases of necrotizing fasciitis and is indicated when this infection is confirmed or suspected 1.
- Features suggestive of necrotizing fasciitis include clinical findings, failure of cellulitis to respond to antibiotics, profound toxicity, skin necrosis, or presence of gas in the soft tissues.
Antibiotic Therapy
- Empiric antibiotic treatment should be broad, covering both aerobes and anaerobes, and may include vancomycin or linezolid plus piperacillin-tazobactam or a carbapenem, or ceftriaxone and metronidazole 1.
- For documented group A streptococcal necrotizing fasciitis, penicillin plus clindamycin is recommended 1.
Surgical Intervention
- 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 intervention 1.
Additional Considerations
- The use of intravenous immunoglobulin (IVIG) in treating streptococcal toxic shock syndrome has not been established 1.
From the Research
Treatment Overview
The treatment for necrotizing fasciitis in pediatrics typically involves a combination of surgical debridement, antibiotic therapy, and supportive care.
- Surgical debridement is a crucial step in the management of necrotizing fasciitis, as it helps to remove the infected tissue and prevent the spread of the infection 2, 3, 4.
- Antibiotic therapy is also essential, as it helps to control the infection and prevent further complications 2, 5, 4.
- Supportive care, such as fluid resuscitation, analgesia, and wound dressing, is also important in the management of necrotizing fasciitis 2, 6.
Surgical Debridement
Surgical debridement is a critical component of the treatment for necrotizing fasciitis in pediatrics.
- The goal of surgical debridement is to remove all infected tissue, including necrotic skin, subcutaneous tissue, and fascia 2, 3, 4.
- Serial surgical debridement may be necessary to ensure that all infected tissue is removed 3.
- The use of negative pressure wound therapy (NPWT) and vacuum-assisted closure (VAC) can be effective in managing the residual wound after surgical debridement 3.
Antibiotic Therapy
Antibiotic therapy is an essential component of the treatment for necrotizing fasciitis in pediatrics.
- Broad-spectrum antibiotics, such as penicillin, an aminoglycoside, and metronidazole, are often used to cover a range of potential pathogens 2, 5, 4.
- The choice of antibiotics should be guided by culture data, as gram stain results may not be reliable 4.
- Antibiotic therapy should be continued until the infection is fully resolved, which may require several weeks of treatment 2, 5.
Conservative Management
Conservative management of necrotizing fasciitis in pediatrics may be possible in some cases.
- Conservative management involves aggressive fluid resuscitation, analgesia, broad-spectrum antibiotics, and dressing with povidone iodine ointment 6.
- This approach can be effective in managing the infection and promoting wound healing, with minimal morbidity and mortality 6.
- However, conservative management may not be suitable for all cases, and surgical debridement may still be necessary in some cases 2, 3, 4.