18
Treatment
Table 2. Treatment of Necrotizing Infections of the Skin,
Fascia and Muscle
First-Line Antimicrobial
Agent Adult Dosage
Mixed Infections Piperacillin-tazobactam
plus
vancomycin
3.37 g q6-8h IV
30 mg/kg/d in 2 divided
doses
Imipenem/cilastatin 1 g q6-8h IV
Meropenem 1 g q8h IV
Ertapenem 1 g daily IV
Cefotaxime
plus
metronidazole
or
clindamycin
2 g q6h IV
500 mg q6h IV
600-900 mg q8h IV
Streptococcus Penicillin
plus
clindamycin
2-4 mu q4-6h IV
600-900 mg q8h IV
Staphylococcus aureus Nafcillin 1-2 g q4h IV
Oxacillin 1-2 g q4h IV
Cefazolin 1 g q8h IV
Vancomycin (for resistant
strains)
30 mg/kg/d in 2 divided
doses IV
Clindamycin 600-900 mg q8h IV
Clostridium species Clindamycin
plus penicillin
600-900 mg q8h IV
2-4 mu q4-6h IV
Aeromonas hydrophila Doxycycline
plus
ciprofloxacin
or
ceriaxone
100 mg q12h IV
500 mg q12h IV
1-2 g q24h IV
Vibrio vulnificus Doxycycline
plus
ceriaxone
or
cefotaxime
100 mg q12h IV
1 g qid IV
2 g tid IV
a
Not to exceed the maximum adult dose.
b
If Staphylococcus present or suspected, add an appropriate agent.
c
If MRSA are present or suspected, add vancomycin.
