Monday, February 9, 2015

Choice of Antibiotics for Necrotising Fasciitis

Emperical Therapy
  • Empiric antibiotics should be started immediately. Initial antimicrobial therapy should be broad-based, to cover aerobic gram-positive and gram-negative organisms and anaerobes. 
  • A foul smell in the lesion strongly suggests the presence of anaerobic organisms. 
  • The maximum doses of the antibiotics should be used, with consideration of the patient's weight and liver and renal status
  • Clindamycin is often added due to  for its antitoxin effects against toxin-elaborating strains of streptococci and staphylococci
Duration
  • no specific duration based on clinical trials
  • based on available recommendations, to use based on clinical response, no requirement for surgical debridements and fever free for at least 48-72 hours.
Acceptable regimens include administration of:

  • A carbapenem or beta-lactam-beta-lactamase inhibitor, plus
  • Clindamycin (dosed at 600 to 900 mg intravenously every eight hours in adults or 40 mg/kg per day divided every eight hours in neonates and children) for its antitoxin effects against toxin-elaborating strains of streptococci and staphylococci), plus
  • An agent with activity against methicillin-resistant S. aureus (MRSA; such as vancomycindaptomycin, or linezolid) (table 3). In neonates and children, vancomycin (15 mg/kg/dose every six to eight hours) is the usual empiric antibiotic for MRSA; the six-hour dosing interval is employed for sicker children
Organism Specific Treatment

Management of Skin and Soft Tissue Infections: 2014 Update IDSA


NAG 2014

Malaysian ICU Antibiotic Guideline 2012



references:

1. www.uptodate.com
2. http://emedicine.medscape.com/article/2012058-overview
3. Practice Guidelines on the Management of Soft Tissue and Skin Infection 2014 (IDSA)

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