Steven Doerr, MD, is a U.S. board-certified Emergency Medicine Physician. Dr. Doerr received his undergraduate degree in Spanish from the University of Colorado at Boulder. He graduated with his Medical Degree from the University Of Colorado Health Sciences Center in Denver, Colorado in 1998 and completed his residency training in Emergency Medicine from Denver Health Medical Center in Denver, Colorado in 2002, where he also served as Chief Resident.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
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.
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
(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
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