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Clinical Features of Necrotising Fasciitis:
If the patient has none of these features, then necrotising fasciitis is unlikely. Follow guidance for:
Early senior surgical review is crucial
DO NOT DELAY SURGICAL REVIEW OR SURGERY TO PERFORM CT SCAN
Recommended total duration: Depends on clinical response, and after discussion with an infection specialist
FIRST DOSE
| Recommended Antibiotic |
Piperacillin-tazobactam 4.5g IV PLUS Clindamycin 1200mg IV |
| Penicillin allergy |
Ciprofloxacin 400mg IV PLUS Clindamycin 1200mg IV PLUS Vancomycin IV (use NHS Lothian Calculator located AMT intranet page) choose 15-20mg/L trough target |
SUBSEQUENT MANAGEMENT
Recommended ongoing treatment if necrotising skin soft tissue infection thought highly likely.
Administer the antibiotics in the order documented.
Consider the use of human intravenous immunoglobulin where Group A Streptococcal infection is possible.
| Recommended Antibiotic |
Flucloxacillin 2g every 6 hours IV PLUS Gentamicin IV (use NHS Lothian Calculator located on AMT intranet page) PLUS Clindamycin 1200mg every 6 hours IV PLUS Metronidazole 500mg every 8 hours IV |
| Penicillin allergy |
Vancomycin IV (use NHS Lothian Calculator located on AMT intranet page) choose 15-20mg/L trough target PLUS Gentamicin IV (use NHS Lothian Calculator located on AMT intranet page) PLUS Clindamycin 1200mg every 6 hours IV PLUS Metronidazole 500mg every 8 hours IV |
Anthrax rarely occurs in Scotland and is usually associated with IV drug use.
Local signs include:
If Anthrax is possible/suspected, add ciprofloxacin 400mg IV every 12 hours to the above regimens if not already included.
For more details see HPS guidance here.
Risk factors: diabetes mellitus, recent surgery, obesity, steroids.
Likely organisms:
