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Necrotizing Fasiitis
Necrotizing Fasiitis
II T
A S
F
N G
Z I
T I
R O
N EC
OUTLINE
Definition
Risk factors
Classification
Pathophysiology
Symptoms
Investigations
Treatment
WHAT IS NECROTIZING FASCIITIS?
Computed
tomography
demonstrates
soft tissue gas
collection from an
Gas
Gas
invasive Group A vesicles
vesicles
Streptococci
Bacteria.
DIFFERENTIAL DIAGNOSES
Acute Epididymitis
Cellulitis
Emergent Treatment of Gas Gangrene
Orchitis
Testicular Torsion in Emergency Medicine
Toxic Shock Syndrome
TREATMENT
Penicillin G (Pfizerpen)
Penicillin G interferes with synthesis of cell wall
mucopeptide during active multiplication, resulting in
bactericidal activity against susceptible microorganisms.
Clindamycin (Cleocin)
Clindamycin is a lincosamide for treatment of serious skin
and soft tissue staphylococcal infections. It is also effective
against aerobic and anaerobic streptococci (except
enterococci). This agent inhibits bacterial growth, possibly
by blocking dissociation of peptidyl transfer RNA (t-RNA)
from ribosomes causing RNA-dependent protein synthesis to
arrest. It is used as an alternative to penicillin G.
Metronidazole (Flagyl)
Metronidazole is an imidazole ringbased antibiotic active
against various anaerobic bacteria and protozoa. It is used
in combination with other antimicrobial agents (except for
Clostridium difficile enterocolitis).
Metronidazole appears to be absorbed into cells of
microorganisms containing nitroreductase. Unstable
intermediate compounds that bind DNA and inhibit synthesis
are formed, causing cell death.
Ceftriaxone (Rocephin)
Ceftriaxone is the drug of choice in initial treatment. It is a
third-generation cephalosporin with broad-spectrum, gram-
negative activity. It has lower efficacy against gram-positive
organisms and higher efficacy against resistant organisms. It
arrests bacterial growth by binding to one or more penicillin-
binding proteins.
Gentamicin
Gentamicin is an aminoglycoside antibiotic for gram-negative
coverage. It is used in combination with both an agent against
gram-positive organisms and one that covers anaerobes. It is
not the drug of choice, but should be considered if penicillins
or other less toxic drugs are contraindicated, when clinically
indicated, and in mixed infections caused by susceptible
staphylococci and gram-negative organisms.
Adjust the dose based on creatinine clearance (CrCl) and
changes in volume of distribution. Follow each regimen by at
least a trough level drawn on the third or fourth dose (0.5 h
before dosing). Peak level may be drawn 0.5 h after a 30-min
infusion
Chloramphenicol
Chloramphenicol binds to 50 S bacterial-ribosomal
subunits and inhibits bacterial growth by inhibiting
protein synthesis. It is effective against gram-negative
and gram-positive bacteria.
Ampicillin
Ampicillin has bactericidal activity against susceptible
organisms. It is an alternative to amoxicillin when the
patient is unable to take medication orally. It may be
added to the initial regimen if the Gram stain suggests
that enterococci are present.
Imipenem and cilastatin (Primaxin)
This combination is used for treatment of infections
due to multiple organisms in which other agents do
not have wide-spectrum coverage or are
contraindicated because of potential for toxicity.
Ampicillin and sulbactam (Unasyn)
This combination of ampicillin and a beta-
lactamase inhibitor covers skin, enteric flora,
and anaerobes. It is not ideal for treatment of
nosocomial pathogens.
Vancomycin (Vancocin)
Vancomycin is an antibiotic directed against
gram-positive organisms and active against
Enterococcus species. It is useful in the
treatment of septicemia and skin-structure
infections. Vancomycin is indicated for
patients who cannot take or whose conditions
fail to respond to penicillins and
cephalosporins or those with infections with
resistant staphylococci.
To prevent toxicity, the current
HYPERBARIC OXYGEN THERAPY (HBOT) IS A MEDICAL
TREATMENT WHICH ENHANCES THE BODY'S NATURAL
HEALING PROCESS BY INHALATION OF 100% OXYGEN IN
A TOTAL BODY CHAMBER, WHERE ATMOSPHERIC
PRESSURE IS INCREASED AND CONTROLLED. IT IS USED
FOR A WIDE VARIETY OF TREATMENTS USUALLY AS A
PART OF AN OVERALL MEDICAL CARE PLAN
PREVENTION!!!