Necrotising fasciitis or rapidly progressing infection in an IVDU

Micro Organisms

Staphylococcus aureus, Streptococcus pyogenes, mixed coliforms, anaerobes

For advice on duration of treatment please contact Medical Microbiology

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

IV Flucloxacillin 2g 6 hourly

+ IV Benzylpenicillin 2.4g 6 hourly

+ Gentamicin^# IV (Hartford Regimen) as per guideline

+ 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

Vancomycin IV as per guideline

Use calculator for intermittent dosing.

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

+ Gentamicin^# IV (Hartford Regimen) as per guideline

Oral switch depending on sensitivities.