Spectrum: Local Antimicrobial Stewardship, for Prisma Health-Midlands

Necrotizing Fasciitis

Consult

Urgent surgical consultation

Please send deep tissue cultures at the time of surgical debridement

Empiric Antimicrobial Therapy

Vancomycin 15 mg/kg IV Q8-12h

  • Loading dose of 20 mg/kg once is recommended

  • Q8h dosing is preferred in young adults

PLUS

Clindamycin 600-900mg IV Q8h

Limit duration to 5 days for suppression of toxin production

PLUS EITHER

Piperacillin/tazobactam 4.5G IV Q6h

OR

Cefepime 2G IV Q8-12h

OR

Ciprofloxacin 400mg IV Q8h

Alternative (including for patients with severe penicillin allergy i.e. anaphylaxis, angioedema, hives, etc.)

De-escalation

Penicillin G 4 million units IV Q4h

If due to beta-hemolytic streptococci (grp A, B, etc.)

OR

Ceftriaxone 2G IV Q24h

If due to beta-hemolytic streptococci (grp A, B, etc.)

PLUS

Clindamycin 600-900mg IV Q8h

Limit duration to 5 days for suppression of toxin production