From the Guidelines
Treatment for Necrotizing Fasciitis in Pediatric Patients with a Penicillin Allergy
For pediatric patients with necrotizing fasciitis and a penicillin allergy, treatment with clindamycin is recommended at a dose of 40 mg/kg/day divided into 3-4 doses, with a maximum dose of 2.7 grams per day 1. Alternatively, vancomycin may be used at a dose of 40-60 mg/kg/day divided into 4 doses, with trough levels maintained between 15-20 mcg/mL 1.
- Key considerations for treatment include:
- The choice between clindamycin and vancomycin should be guided by the suspected or confirmed causative pathogens and local resistance patterns, with clindamycin being a suitable option for patients with severe penicillin hypersensitivity 1.
- Duration of treatment is typically 7-14 days, depending on clinical response and extent of disease, with the goal of completing a full course to ensure eradication of the infection.
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. Serious skin and soft tissue infections; septicemia; Pediatric Patients (for children who are able to swallow capsules): Serious infections – 8 to 16 mg/kg/day (4 to 8 mg/lb/day) divided into three or four equal doses.
The treatment for necrotizing fasciitis in pediatric patients with a penicillin allergy is clindamycin. The recommended dosage is 8 to 16 mg/kg/day divided into three or four equal doses for serious infections 2.
- Key considerations:
- Clindamycin is effective against susceptible anaerobic bacteria, streptococci, pneumococci, and staphylococci.
- The dosage should be based on total body weight, regardless of obesity.
- Clindamycin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria 2.
- Alternative options:
- Vancomycin may be considered for methicillin-resistant staphylococci infections 3.
From the Research
Treatment for Necrotizing Fasciitis in Pediatric Patients with a Penicillin Allergy
- The mainstay of treatment for necrotizing fasciitis is early diagnosis and surgical intervention, along with antimicrobial therapy 4.
- For pediatric patients, early aggressive surgical treatment is the treatment of choice 5.
- In cases where patients have a penicillin allergy, alternative antibiotics such as clindamycin and amoxy-clavulanate can be used, as most isolates are sensitive to these medications 6.
- The treatment approach may involve repeated débridements to ensure that disease progression has been halted, and broad-spectrum antibiotics to cover a range of bacterial pathogens 7.
- It is essential to note that the clinical presentation and treatment outcomes of necrotizing fasciitis can differ between children and adults, and patients with adverse prognostic factors may benefit from early referral to a facility with a critical care unit 8.
Key Considerations
- Pediatric necrotizing fasciitis has distinguishing features that differ from adult necrotizing fasciitis, including triggers, symptoms, and laboratory and microbiological findings 5.
- Monomicrobial necrotizing fasciitis is more common than polymicrobial fasciitis in pediatric patients, and Streptococci, Staphylococci, and Pseudomonas aeruginosa are often isolated 5.
- Prognostic factors for mortality in pediatric necrotizing fasciitis include categorization as "Sick," body surface area involvement >10%, thrombocytopenia, raised serum creatinine, late debridement, and polymicrobial blood culture isolates 6.