Necrotizing Fasciitis

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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