Pediatric Guidelines: Skin & Soft Tissue Infections - Necrotizing Fasciitis

Condition Major Pathogens First Choice Therapy Alternative Therapy Comments
Necrotizing fasciitis or other necrotizing soft tissue infection

Group A streptococcus

Can be polymicrobial including anaerobes, Clostridium spp, skin flora


Age 3mo-<12yo: 17.5 mg/kg/dose IV q6h (initial max 1g/dose)

Age >=12 yo: 15 mg/kg/dose IV q6h (initial max 1g/dose)


Piperacillin-tazobactam 100mg/kg/dose IV q6h (max 4g piperacillin/dose)


Clindamycin 10mg/kg/dose IV q8h (max 900mg/dose)

Beta lactam allergy:

Consult ID/ASP for guidance on alternative therapy

ID and Surgery consults recommended

These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP).