Neobook — clinical reference

Infection	Necrotising fasciitis
Brief outline/clinical setting	Life-threatening, invasive, rapidly progressive soft-tissue infection with a necrotising component involving the deeper fascia. Characteristics associated with increased likelihood of necrotizing infection: - Oedema - Erythema - Severe and crescendo pain out of proportion - Cutaneous anaesthesia - Skin bullae or necrosis (at later stages) - Swelling or tenderness beyond area of erythema - Crepitus - Systemic toxicity Monomicrobial infections: often a predisposing condition, such as diabetes, arteriosclerotic vascular disease, vascular insufficiency, ulcer, or IV drug use Polymicrobial: most commonly associated with 4 clinical settings: (1) perianal abscesses, penetrating abdominal trauma, or surgical procedures involving the bowel; (2) decubitus ulcers; (3) injection sites in illicit drug users; and (4) spread from a genital site
Aetiologies/organisms	Monomicrobial: Group A streptococci, S. aureus, Aeromonas hydrophila, Vibrio vulnificus, anaerobic streptococci Polymicrobial: mixed anaerobes (e.g. Clostridium perfringens) and aerobic gram negative organisms, mostly originating from the bowel or genitourinary flora
Optimal antimicrobial selection	Piperacillin-tazobactam 4.5g 8 hourly IVI (PLUS antibiotic that inhibit toxin production if S.pyogenes implicated e.g. clindamycin 600mg 8 hourly IVI)
Duration	Antibiotic therapy should be administered until further debridement is no longer necessary, the patient has improved clinically, and fever has resolved for 48–72 h
Alternative if allergic/not available	Ciprofloxacin 400mg 8 hourly IVI PLUS metronidazole 500mg 8 hourly IVI PLUS vancomycin (loading dose 20-30mg/kg, followed by 15-20mg/kg; maintain trough levels at 15–20mg/mL)
Rationale	The use of antimicrobial therapy is an adjuvant treatment and must be combined with early surgical debridement (every 24h – 48h)
Level of evidence	Guidelines (Strong recommendation, moderate-quality) evidence
Link to Guideline	Click here

Necrotising Fasciitis

Drugs mentioned