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Hospitalized Adults: Skin and Soft Tissue Infections: Necrotizing fasciitis

Doses provided in this table are for patients with normal renal and hepatic function. Click on drug link to go to dosing guidelines.
Some antimicrobials are restricted (ID-R). Click on link for guidelines on obtaining authorization.

Common Alternative
Diagnosis Drug(s) of First Choice Comments
Pathogens Drug(s)
 Vancomycin [1]

PLUS ONE OF:

Piperacillin/tazobactam [2]ID-
R: SFGH [3] 4.5 g IV q6-8h

OR
For severe PCN
Ertapenem [2]1 g IV daily allergy:
Emergent ID and surgical consultation
ALL WITH: Vancomycin [1] recommended.
Group A
streptococci Clindamycin [2]ID-R: VASF [4] PLUS
Necrotizing 600 ? 900 mg IV q8h
S. aureus Aztreonam [2]ID- Clindamycin added for anti-toxin
fasciitis or
R: SFGH [3] 2 g IV properties. Limited data support use
suspected deep Anaerobes
tissue extension q8h for infections caused by Group A
Alternatively if infection is streptococci and Clostridium
Gram-negative
health-care associated: PLUS perfringens. Discontinue clindamycin
rods
once adequate surgical debridement
Vancomycin [1] Clindamycin [2] ID- is achieved.
R: VASF [4] 600-
PLUS 900 mg IV q8h

Meropenem [2]ID-R: SFGH [3]

VASF [4] 1-2 g IV q8h

PLUS

Clindamycin [2]ID-R: VASF [4]

600-900 mg IV q8h

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Source URL: https://idmp.ucsf.edu/hospitalized-adults-skin-and-soft-tissue-infections-necrotizing-fasciitis?mag_q=printpdf/266

Links
[1] http://idmp.ucsf.edu/vancomycin-dosing-and-monitoring-recommendations
[2] http://idmp.ucsf.edu/adult-antimicrobial-dosing-non-dialysis
[3] http://idmp.ucsf.edu/restricted-antimicrobials-san-francisco-general-hospital
[4] http://idmp.ucsf.edu/restricted-antimicrobials-veterans-affairs-medical-center-san-francisco