From the FDA Drug Label
Clindamycin is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. Clindamycin is also indicated in the treatment of serious infections due to susceptible strains of streptococci, pneumococci, and staphylococci Its use should be reserved for penicillin-allergic patients or other patients for whom, in the judgment of the physician, a penicillin is inappropriate. Vancomycin Hydrochloride for Injection, USP is indicated for the treatment of serious or severe infections caused by susceptible strains of methicillin-resistant (β-lactam-resistant) staphylococci It is indicated for penicillin-allergic patients, for patients who cannot receive or who have failed to respond to other drugs, including the penicillins or cephalosporins, and for infections caused by vancomycin-susceptible organisms that are resistant to other antimicrobial drugs
The treatment options for necrotizing fasciitis in pediatric patients with a penicillin allergy are:
- Clindamycin: may be used to treat serious skin and soft tissue infections, including those caused by susceptible strains of streptococci, pneumococci, and staphylococci 1
- Vancomycin: may be used to treat serious or severe infections caused by susceptible strains of methicillin-resistant staphylococci, including skin and skin structure infections 2 Pediatric dosing:
- Clindamycin: 8 to 16 mg/kg/day (4 to 8 mg/lb/day) divided into three or four equal doses for serious infections, and 16 to 20 mg/kg/day (8 to 10 mg/lb/day) divided into three or four equal doses for more severe infections 1 Note: The dosage and administration of vancomycin in pediatric patients is not specified in the provided drug labels.
From the Research
Treatment Options for Necrotizing Fasciitis in Pediatric Patients with a Penicillin Allergy
- The primary treatment for necrotizing fasciitis involves prompt surgical debridement of affected tissue and broad-spectrum antibiotics 3, 4, 5, 6, 7.
- For pediatric patients with a penicillin allergy, alternative antibiotics such as clindamycin and/or metronidazole can be used as initial calculated antibiotic treatment 4.
- The choice of antibiotic therapy should be guided by the results of microbiological cultures and sensitivity testing 4.
- Surgical debridement is the mainstay of treatment, and multiple sessions may be necessary to ensure complete removal of infected tissue 3, 4, 6, 7.
- In addition to surgical and antibiotic treatment, supportive care such as wound management and pain control are also important aspects of treatment 3, 6, 7.
- The use of aminopenicillin ± sulbactam in combination with clindamycin and/or metronidazole is recommended as initial calculated antibiotic treatment for necrotizing fasciitis, but this may need to be adjusted in patients with a penicillin allergy 4.
Key Considerations
- Early diagnosis and treatment are critical to improving outcomes in pediatric patients with necrotizing fasciitis 3, 5, 6, 7.
- A high index of clinical suspicion is necessary to promptly diagnose and treat necrotizing fasciitis, especially in pediatric patients with nonspecific initial symptoms 3, 6, 7.
- The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score can be a useful tool in diagnosing necrotizing fasciitis, but it should be used in conjunction with clinical judgment and other diagnostic modalities 3, 7.