Hospitalized Adults: Skin and Soft Tissue Infections: Necrotizing fasciitis

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Doses provided in this table are for patients with normal renal and hepatic function. Click on drug link to go to dosing guidelines.  Some antimicrobials are restricted (ID-R).  Click on link for guidelines on obtaining authorization.

Diagnosis

Common Pathogens

Drug(s) of First Choice

Alternative Drug(s)

Comments

Necrotizing fasciitis or suspected deep tissue extension

Group A streptococci

S. aureus

Anaerobes

Gram-negative rods

Vancomycin

PLUS ONE OF:

Piperacillin/tazobactamID-R: SFGH 4.5 g IV q6-8h 

OR

Ertapenem 1 g IV daily

ALL WITH:

ClindamycinID-R: VASF 600 – 900 mg IV q8h

 

Alternatively if infection is health-care associated:

Vancomycin

PLUS

MeropenemID-R: SFGH VASF 1-2 g IV q8h

PLUS

ClindamycinID-R: VASF 600-900 mg IV q8h

For severe PCN allergy:

Vancomycin

PLUS

AztreonamID-R: SFGH 2 g IV q8h

PLUS

Clindamycin ID-R: VASF 600-900 mg IV q8h

Emergent ID and surgical consultation recommended.

 

Clindamycin added for anti-toxin properties. Limited data support use for infections caused by Group A streptococci and Clostridium perfringens. Discontinue clindamycin once adequate surgical debridement is achieved.