Necrotizing Fasciitis (cont.)
Are There Home Remedies for Necrotizing Fasciitis?
Necrotizing fasciitis is an emergency condition that cannot be managed at home. Patients with necrotizing fasciitis require hospital admission, appropriate IV antibiotics, surgical debridement, and close observation in an intensive-care unit.
What Are Treatments for Necrotizing Fasciitis?
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 for Necrotizing Fasciitis
- 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.
- There are various antibiotic regimens available, which may involve monotherapy or multidrug regimens. Commonly recommended antibiotics include penicillin, ampicillin-sulbactam (Unasyn), 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 type of bacteria.
- 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) for Necrotizing Fasciitis
- 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 certain 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. However, this should not delay definitive surgical management.
Intravenous Immunoglobulin (IVIG) for Necrotizing Fasciitis
- Some investigators feel that IVIG may be a useful adjunct treatment in certain cases of streptococcal necrotizing fasciitis, as it has been shown to successfully neutralize streptococcal exotoxins in Streptococcal toxic shock syndrome (STSS). However, its use is controversial in necrotizing fasciitis and therefore it is not considered to be the standard of care.
Surgery for Necrotizing Fasciitis
Rapid surgical debridement of infected tissue is the cornerstone of treatment in cases of necrotizing fasciitis. Early detection and prompt surgical intervention has been shown to decrease morbidity and mortality, underscoring the importance of early surgical involvement and consultation.
- Extensive surgical debridement of all necrotic tissue is required. Wide and deep incisions may be necessary to excise all infected tissue (fascia, muscle, skin, etc) until healthy, viable tissue is visualized.
- Repeated surgical debridement is often necessary within the ensuing hours to days after the initial surgical intervention, as progression of the disease may be sudden, severe, and unrelenting. Sepsis may lead to other infection sites and those areas may need surgical intervention, resulting in some patients requiring multiple amputations.
- In some cases, despite repeated surgical debridement, a life-saving amputation may be necessary if the necrosis is too widespread and the imminent risk of overwhelming sepsis and death is felt to be present.
Medically Reviewed by a Doctor on 10/26/2016
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