Spectrum: Local Antimicrobial Stewardship, for Markham Stouffville Hospital

Necrotizing Fasciitis

Note

Early and aggressive surgical debridement of all necrotic tissue is essential.

Clinical Features

  • Rapid progression

  • Pain out of proportion

  • Systemic signs of sepsis and organ dysfunction

  • Signs of deeper infection (skin sloughing, bullae)

  • Profound systemic toxicity

  • Advancement of infection during antibiotic therapy

  • Skin necrosis

  • Presence of gas

Common Pathogens

Streptococcus pyogenes
(Group A β-hemolytic streptococci)

Polymicrobial

Empiric Regimen of Choice

Treat as severe, non-purulent SSTI until C&S confirmation

Treatment of Severe SSTI

Definitive Regimen for proven Group A Streptococci

Penicillin G

Penicillin G Dosing

AND

Clindamycin

Clindamycin Dosing

Duration of Therapy

Intravenous treatment until further debridement no longer necessary and has improved clinically and fever has been absent for 48–72 hours.

Stepdown and total duration of therapy based on clinical progression.