Necrotizing fasciitis

Click on any antibiotic to mark it as excluded from print.

Necrotizing fasciitis
Definition Signs/ Symptoms Management
Initial Empirical Therapy Comment
Infection of the deep soft tissues that results in progressive destruction of muscle fascia and overlying subcutaneous fat. Erythema, edema , severe pain, fever, crepitus, skin bullae , necrosis or ecchymosis.

Select one of the following antibiotics:

  • Imipenem/Cil 1 g IV every 6 - 8 hours
  • Meropenem 1 g IV every 8 hours
  • Ertapenem 1 g IV every 24 hours
  • Piperacillin/Tazobactam 4.5 g IV every 8 hours

Plus:

Select one of the following:

  • Vancomycin 15 - 20 mg/kg/dose IV every 8 - 12 hours
  • Daptomycin 4- 6 mg/kg IV once daily

Plus:

  • Clindamycin 600 - 900 mg IV every 8 hours
for patients with necrotizing fasciitis due to beta-hemolytic streptococci or S.aureus that are resistant to clindamycin , linezolid 600 mg IV every 12 hours can be used (as antitoxin).
Duration: Antibiotics should be continued until no further debridement is needed and the patient's hemodynamic status has normalized (at least two weeks)
References:

Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 , last update 2018