Necrotising fasciitis or rapidly progressing infection in an IVDU

Micro-organism

Staphylococcus aureus, Streptococcus pyogenes, mixed coliforms, anaerobes

Duration

For advice on duration of treatment please contact Medical Microbiology

Notes
  • A medical and surgical emergency – seek urgent medical microbiology and surgical advice.
  • Consider early debridement/ exploration
  • Send blood and tissue for culture
  • Take appropriate specimens before starting therapy, consult dermatologist and medical microbiologist for patients with severe or recurrent infection
  • Consider the necessity for surgical intervention, tetanus prophylaxis and topical cleaning
1st Line

IV Flucloxacillin 2g 6 hourly

+ IV Benzylpenicillin 2.4g 6 hourly

+ Gentamicin# IV (Hartford Regimen) as per guideline

Use preferred calculator on Hospital portals page [intranet access only] or calculator on app

+ IV Clindamycin 600mg-1.2g 6 - 8 hourly

 

Switch to

Oral Flucloxacillin 500mg-1g 6 hourly

+ Amoxicillin 500mg-1g 8 hourly

+ Clindamycin 600mg 8 hourly

Penicillin Allergy

Vancomycin IV as per guideline

Use preferred calculator on Hospital portals page [intranet access only] or calculator on app for intermittent dosing.

+ IV Clindamycin 600mg-1.2g 6 - 8 hourly

+ Gentamicin# IV (Hartford Regimen) as per guideline

Use preferred calculator on Hospital portals page [intranet access only] or calculator on app

 

Oral switch depending on sensitivities.