Necrotizing Skin and Soft Tissue Infection - Treatment

Consults and Duration of Therapy

Necrotizing fasciitis is considered a surgical emergency. Consultation with the appropriate surgical service and Infectious Diseases is strongly recommended.

Specific therapy and duration depends on achieving adequate source control and should be guided with input from the Infectious Diseases service.

Notes

Droplet / Contact Precautions

Patients with severe skin and soft tissue infections that could be due to invasive group A streptococcus should be on contact/droplet precautions for 24h after initiation of appropriate and effective therapy.

Prophylaxis of household contacts may be required for invasive Group A streptoccal infections and Public Health should be notified.

Administer antimicrobials within one hour for patients with sepsis and severe skin and soft tissue infection

Consider IVIG in consultation with Infectious Diseases.

Suggested Empiric Antimicrobial Regimen

Piperacillin-tazobactam 3.375g IV q6h

AND

Clindamycin 600-900mg IV q8h

AND

Vancomycin 25mg/kg IV load followed by 15mg/kg IV maintenance for a target trough of 15-20µg/mL

Consider discontinuation of vancomycin if MRSA is not identified in deep tissue specimens.

Severe Beta-Lactam Allergy

Ciprofloxacin 400mg IV q8-12h

AND