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Necrotizing Fasciitis (cont.)

Necrotizing Fasciitis Medical Treatment

When the diagnosis of necrotizing fasciitis is highly suspected or confirmed, immediate measures must be taken to initiate treatment and quickly intervene in order to reduce morbidity and mortality. The medical treatment of necrotizing fasciitis primarily involves the administration of antibiotics, with hyperbaric oxygen therapy and intravenous immunoglobulin (IVIG) administration used much less commonly. Definitive treatment for necrotizing fasciitis, however, ultimately requires surgical intervention.

  • Initial management includes patient stabilization, including supplemental oxygen, cardiac monitoring, and intravenous fluid administration.
  • Some patients with sepsis may require the administration of intravenous medications to increase blood pressure and/or the insertion of a breathing tube (intubation) in cases of severe illness or respiratory compromise.
  • Close monitoring and supportive care in an intensive-care unit is required.

Antibiotics

  • Broad-spectrum antibiotics should be started immediately. As the responsible organism(s) may not be known initially, antibiotics should include coverage for a wide array of organisms, including aerobic gram-positive and gram-negative bacteria, as well as anaerobes. Consideration for infection caused by MRSA must also be taken into account. Consultation with an infectious disease specialist may be helpful.
  • There are various antibiotic regimens available, which may involve monotherapy or multidrug regimens. Commonly recommended antibiotics include penicillin, clindamycin (Cleocin HCl, Cleocin Pediatric), aminoglycosides, metronidazole (Flagyl, Flagyl 375, Flagyl ER), cephalosporins, carbapenems, vancomycin (Lyphocin, Vancocin HCl, Vancocin HCl Pulvules), and linezolid (Zyvox). Most clinicians treat with more than one IV antibiotic because bacteria causing necrotizing fasciitis are often resistant to more than one antibiotic and some infections are caused by more than one bacterial genus.
  • Antibiotic coverage can be adjusted once culture results identify the causative organism(s) and antibiotic sensitivity results are available. Antibiotic sensitivity testing is required to adequately treat MRSA and the new NDM-1 antibiotic resistant strains of bacteria.

Hyperbaric oxygen therapy (HBO)

  • This therapy delivers highly concentrated oxygen to patients in a specialized chamber, thereby increasing tissue oxygenation. This inhibits anaerobic bacteria and promotes tissue healing.
  • Some investigators feel that HBO reduces mortality in some patients when used in conjunction with an aggressive treatment regimen that includes surgery and antibiotics.
  • HBO is not widely available, therefore, consultation with a hyperbaric specialist may be necessary.

Intravenous immunoglobulin (IVIG)

  • Some investigators feel that IVIG may be a useful adjunct treatment in cases of streptococcal necrotizing fasciitis, as it has been shown to successfully neutralize streptococcal exotoxins in Streptococcal toxic shock syndrome (STSS).
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