Necrotizing Fasciitis
exp date isn't null, but text field is
Life threatening progressive rapidly spreading inflammatory infection located in deep fascia, most commonly caused by Streptococcus species or polymicrobial
Clinical presentation of Necrotizing Fasciitis
- Early signs and symptoms mimic acute osteomyelitis
- Foul smelling discharge
- Late-stage multiple discoloration develops a large area of gangrenous skin
- Presence of features of toxic shock
Investigations
- Complete blood count (CBC)
- Erythrocyte sedimentation rate (ESR)
- C – Reactive Protein test (CRP)
- Ultrasound
- Plain X-ray
- Muscle biopsy for culture and sensitivity
Pharmacological Treatment
A: gentamycin (IV) 80mg 8hourly for 7days
AND
B: chloramphenicol (IV) 500mg 6hourly +/- S: clindamycin (IV) 600mg 8hourly for 7days
Alternatively
A: benzathine benzylpenicillin (IV) 2-4MU 6hourly for 7days
AND
S: clindamycin (IV) 600mg 8hourly +/- ciprofloxacin 400mg (IV) 8hourly for 7days
Alternatively
A: benzathine benzylpenicillin (IV) 2-4MU 6hourly for 7days
AND
S: clindamycin 600mg (IV) 8hourly for 7days
OR
S: vancomycin 1g 12hourly for 7days
Note: Adjust treatment based on culture and sensitivity results. Repeat serial CRP, FBP, ESR starting 48hours after initiation of appropriate treatment until normalized.
Surgical management
- Serial extensive surgical debridement
- Skin grafting once the wound granulates with no sign of infection
Supportive treatment
- Hydration
- Rest
- Nutritional support
- Addressing the predisposing condition
- Antipyretic for fever
- Analgesics for pain
- Physiotherapy to improve range of motion of nearby joint