From the Guidelines
Treatment for necrotizing fasciitis requires immediate surgical debridement combined with broad-spectrum antibiotic therapy, as recommended by the 2014 IDSA SSTI guidelines, which is the most relevant and recent guideline available. Surgical intervention should be performed as soon as possible, as delays significantly increase mortality. The recommended empiric antibiotic regimen includes vancomycin or linezolid (for MRSA coverage) plus piperacillin-tazobactam or a carbapenem (meropenem, imipenem, or ertapenem), or ceftriaxone plus metronidazole, as stated in the guidelines 1.
Key Considerations
- Prompt surgical consultation is crucial for patients with aggressive infections associated with signs of systemic toxicity or suspicion of necrotizing fasciitis or gas gangrene, as recommended by the guidelines 1.
- Empiric antibiotic treatment should be broad, covering both aerobic and anaerobic microbes, as well as MRSA, as the etiology can be polymicrobial or monomicrobial 1.
- Penicillin plus clindamycin is recommended for treatment of documented group A streptococcal necrotizing fasciitis, as stated in the guidelines 1.
Additional Treatment Options
- For patients with suspected group A streptococcal infection, adding clindamycin (600-900 mg IV every 8 hours) is recommended to suppress toxin production.
- Intravenous immunoglobulin (IVIG) at 1 g/kg on day one, with possible additional doses on days 2 and 3, may be considered for patients with streptococcal toxic shock syndrome.
- Hyperbaric oxygen therapy might be beneficial as an adjunctive treatment in some cases, though evidence is limited.
Treatment Duration
- Antibiotic therapy should continue until no further debridements are needed, the patient has clinically improved, and fever has been absent for 48-72 hours.
- Frequent reassessment for additional surgical debridement is essential throughout treatment, as multiple operations are often necessary to control the infection.
From the Research
Treatments for Necrotizing Fasciitis
The 2017 IDSA SSTI guidelines are not directly mentioned in the provided studies, but the treatments for necrotizing fasciitis can be summarized as follows:
- Surgical debridement: Radical surgical debridement is considered a cornerstone of treatment 2, and repeated surgical debridement of necrotic tissues is a crucial part of treatment 3, 4.
- Antibiotics: Broad-spectrum antibiotics are considered essential in the treatment of necrotizing fasciitis 2, 3.
- Adjuvant therapies: Hyperbaric oxygen therapy (HBOT) 2, 3 and intravenous immunoglobulin (IVIG) 3 may have a role in the treatment of necrotizing fasciitis.
- Negative pressure wound therapy: This therapy has been shown to be useful in improving wound bed preparation and healing 5.
- Soft tissue reconstruction: May be necessary following surgery 3.
Key Points
- Early diagnosis and aggressive surgical management are critical in the treatment of necrotizing fasciitis 4.
- Prompt diagnosis and proper medical and surgical management can improve outcomes 3.
- The treatment of necrotizing fasciitis requires a multidisciplinary approach, including surgery, antibiotics, and adjuvant therapies.