Important: Therapy
Treat patients presenting with septic shock following the guidance for necrotising fasciitis.
Notes:
SSTIs in injecting drug users can be caused by a large variety of pathogens, including S. aureus and Group A Streptococcus/S. pyogenes, which are common in all types of SSTI, but also by anaerobes, environmental organisms and gram negative enterobacteriaceae, especially if the injection site is in the groin area.
- Pillar 1: Cover for gram positive organisms (mainly beta-haemolytic streptococci and aureus)
- Pillar 2: Cover for gram negative organisms
- Pillar 3: Cover for anaerobic organisms
Patients with acute or chronic impairment of renal function and an eGFR <20mL/min and those with decompensated alcoholic liver disease are at increased risk of adverse events with gentamicin. IV temocillin (adjusted to renal function) is a beta-lactam antimicrobial with a comparable breadth of gram negative cover which can replace gentamicin in these patient populations, provided they do not have a history of penicillin allergy.
Do not administer gentamicin to patients with Myasthenia gravis as it risks precipitating myasthenic gravis.