Necrotising fasciitis or rapidly progressing infection in an IVDU

Micro Organisms

Staphylococcus aureus, Streptococcus pyogenes, mixed coliforms, anaerobes

Duration

For advice on duration of treatment please contact Medical Microbiology

Notes

Therapy

  • A medical and surgical emergency – seek urgent medical microbiology and surgical advice.
  • Consider early debridement/ exploration
  • Send blood and tissue for culture
  • Take appropriate specimens before starting therapy, consult dermatologist and medical microbiologist for patients with severe or recurrent infection
  • Consider the necessity for surgical intervention, tetanus prophylaxis and topical cleaning

1st Line

Therapy

IV Flucloxacillin 2g 6 hourly

+ IV Benzylpenicillin 2.4g 6 hourly

+ Gentamicin# IV (Hartford Regimen) as per guideline

Use preferred calculator on Hospital portals page [intranet access only] or calculator on app

+ IV Clindamycin 600mg-1.2g 6 - 8 hourly

 

Switch to

Oral Flucloxacillin 500mg-1g 6 hourly

+ Amoxicillin 500mg-1g 8 hourly

+ Clindamycin 600mg 8 hourly

Penicillin Allergy

Therapy

Vancomycin IV as per guideline

Use preferred calculator on Hospital portals page [intranet access only] or calculator on app for intermittent dosing.

+ IV Clindamycin 600mg-1.2g 6 - 8 hourly

+ Gentamicin# IV (Hartford Regimen) as per guideline

Use preferred calculator on Hospital portals page [intranet access only] or calculator on app

 

Oral switch depending on sensitivities.