Necrotising fasciitis and other necrotising skin and soft tissue infections

NOTES

  • If suspected seek urgent surgical review with a view to surgical exploration / debridement. Tissue samples from surgery (as well as blood cultures) should be sent for urgent microbiological investigation.
  • In suspected life threatening necrotising staphylococcal sepsis or staphylococcal / streptococcal toxic shock syndrome, discuss the possible additional use of intravenous immunoglobulin (2g/kg) with consultant microbiologist or consultant haematologist.

 

Severity
(classification)

1st line oral/iv antibiotics

Penicillin allergy
(see explanatory notes)

A/B/C

Grading not applicable

Review doses in renal impairment

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A/B/C

Grading not applicable

Review doses in renal impairment

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Follow 1 or 2 based on site of infection

__________________________

 1. Associated with suspected intra-abdominal / pelvic / perineal / genital source (including post-surgical infection at these sites)

DAPTOMYCIN 6mg/kg iv od
(usually rounded up to whole vial):
Less than 45kg: 6mg/kg iv od
46-60kg: 350mg iv od
61-85kg: 500mg iv od
86-115kg: 700mg iv od
116-140kg: 850mg iv od
Greater than 140kg: Initial dose based on body weight, discuss ongoing dose with microbiology.
Plasma CPK should be measured at baseline and at regular intervals.

PLUS

MEROPENEM 2g iv tds

PLUS

METRONIDAZOLE 500mg iv tds

PLUS

GENTAMICIN 3-5mg/kg iv (as per local protocol)

(NOTE: If suspected co-exisiting lower respiratory tract infection discuss with consultant microbiologist)

 

 

 

 

 

 

 

 

 

 

------------------------------------------------

2. Infection at sites other than those listed above:

DAPTOMYCIN 6mg/kg iv od
(usually rounded up to whole vial):
Less than 45kg: 6mg/kg iv od
46-60kg: 350mg iv od
61-85kg: 500mg iv od
86-115kg: 700mg iv od
116-140kg: 850mg iv od
Greater than 140kg: Initial dose based on body weight, discuss ongoing dose with microbiology.
Plasma CPK should be measured at baseline and at regular intervals.

PLUS

CLINDAMYCIN 1.2g iv qds

PLUS

MEROPENEM 2g iv tds

PLUS

GENTAMICIN 3-5mg/kg iv (as per local protocol)

(NOTE: If suspected co-exisiting lower respiratory tract infection discuss with consultant microbiologist)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Follow 1 or 2 based on site of infection

 __________________________

1. Associated with suspected intra-abdominal / pelvic / perineal / genital source (including post-surgical infection at these site)

Non-severe penicillin allergy:
As for non-penicillin allergy (see left hand column)

Severe penicillin allergy:
DAPTOMYCIN 6mg/kg iv od
(usually rounded up to whole vial):
Less than 45kg: 6mg/kg iv od
46-60kg: 350mg iv od
61-85kg: 500mg iv od
86-115kg: 700mg iv od
116-140kg: 850mg iv od
Greater than 140kg: Initial dose based on body weight, discuss ongoing dose with microbiology.
Plasma CPK should be measured at baseline and at regular intervals.

PLUS

CIPROFLOXACIN 400mg iv tds

PLUS

METRONIDAZOLE 500mg iv tds

PLUS

GENTAMICIN 3-5mg/kg iv (as per local protocol

(NOTE: If suspected co-exisiting lower respiratory tract infection discuss with consultant microbiologist)

 

 

 

 

 

 -----------------------------------------------

2. Infection at sites other than those listed above:

Non-severe penicillin allergy:

DAPTOMYCIN 6mg/kg iv od
(usually rounded up to whole vial):
Less than 45kg: 6mg/kg iv od
46-60kg: 350mg iv od
61-85kg: 500mg iv od
86-115kg: 700mg iv od
116-140kg: 850mg iv od
Greater than 140kg: Initial dose based on body weight, discuss ongoing dose with microbiology.
Plasma CPK should be measured at baseline and at regular intervals.

 PLUS

CLINDAMYCIN  1.2g iv qds

PLUS

MEROPENEM 2g iv tds

PLUS

GENTAMICIN 3-5mg/kg iv (as per local protocol)

(NOTE: If suspected co-exisiting lower respiratory tract infection discuss with consultant microbiologist)

Severe penicillin allergy:
DAPTOMYCIN 6mg/kg iv od
(usually rounded up to whole vial):
Less than 45kg: 6mg/kg iv od
46-60kg: 350mg iv od
61-85kg: 500mg iv od
86-115kg: 700mg iv od
116-140kg: 850mg iv od
Greater than 140kg: Initial dose based on body weight, discuss ongoing dose with microbiology.
Plasma CPK should be measured at baseline and at regular intervals.

PLUS

CLINDAMYCIN  1.2g iv qds

PLUS

CIPROFLOXACIN 400mg iv tds

PLUS

METRONIDAZOLE 500mg iv tds

PLUS

GENTAMICIN 3-5mg/kg iv (as per local protocol)

(NOTE: If suspected co-exisiting lower respiratory tract infection discuss with consultant microbiologist)

 

 

 

IV to Oral Switch(explanatory notes)

Based on microbiology results and discussion with consultant microbiologist

Duration

 Discuss with consultant microbiologist

Last Reviewed: 09/05/2017

/or guidance on the administration of intravenous antibiotics /
click here (GHNHSFT intranet only)