Pharmacologic Treatment

As an adjunct to surgery, broad-spectrum IV antibiotic therapy should be initiated immediately in patients with NF. Piperacillin/tazobactam or a carbapenem is appropriate for empiric therapy. These agents should be used in combination with vancomycin, daptomycin, or linezolid until MRSA infection is ruled out. The protein synthesis inhibitors clindamycin or linezolid are often utilized to decrease bacterial toxin production, thereby limiting tissue damage. This is particularly beneficial in streptococcal or clostridial infection. 4

If GAS or C. perfringens is identified as the sole causative organism from deep tissue culture, antimicrobial therapy can be narrowed to high-dose IV penicillin G plus clindamycin. Antibiotic therapy should be continued until further operative débride-ments are unnecessary, the patient displays substantial clinical improvement, and fevers have abated for at least 48 to 72 hours.1

IV immune globulin (IVIG) may also be a usefuladjunctive treatment in patients with GAS NF who present with shock. In one small randomized study, IVIG was associated with a reduction in mortality in such patients, however the finding was not

statistically significant.

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