Necrotizing fasciitis/myositis in Adults - Culture proven

- Use of IV immune globulin (1-2g/kg/day x 2 days) could be considered if streptococcal toxic shock also present.

S. pyogenes (Group A Strep)

- Invasive Group A Streptococci is reportable to Public Health.

- Prophylaxis of contacts of invasive Group A Streptococci is recommended by most Public Health experts. See Prophylaxis for Contacts of Communicable Diseases.

 

Therapy Dose Duration
Penicillin 4MU IV q4h 10-14 days
+    
Clindamycin 600-900mg IV q8h Continue until hemodynamically stable and initial debridement complete (1-3 days)

S. agalactiae (Group B Strep)

Group C, G Strep

S. pneumoniae

Pen MIC ≤ 0.12µg/mL

Therapy Dose Duration
Penicillin 4MU IV q4h 10-14 days
+    
Clindamycin 600-900mg IV q8h Continue until hemodynamically stable and initial debridement complete (1-3 days)

Pen MIC > 0.12µg/mL

Therapy Dose Duration
Ceftriaxone 2g IV daily 10-14 days
+    
Clindamycin 600-900mg IV q8h Continue until hemodynamically stable and initial debridement complete (1-3 days)

Methicillin-susceptible S. aureus (MSSA)

Therapy Dose Duration
Cloxacillin 2g IV q4h 10-14 days
+    
Clindamycin 600mg IV q8h Continue until hemodynamically stable and initial debridement complete (1-3 days)

MRSA

Therapy Dose Duration
Vancomycin 15mg/kg IV q8-12h 10-14 days

Alternative

Therapy Dose Duration
Linezolid 600mg IV/PO q12h 10-14 days
or    
Clindamycin 600mg IV q8h 10-14 days