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Necrotizing Fasciitis - #PHARMFAX

Necrotizing fasciitis is a rapid and deadly progression of a skin infection into the fasciia.


Necrotizing fasciitis is a rapid and deadly progression of a skin infection into the fasciia. Common sites of infection are limbs and digits. Necrotizing genital involvement is called Fournier’s Gangrene. The progression goes from erythema, skin ischemia with blisters and bullae, and then multiorgan failure with severe septic shock. Most cases are polymicrobial and associated with gas production in soft tissue space, such as Streptococcus pyogenes which is a GAS. Pull a three piece PHARMFAX combo from the drug bank. Patients will get vancomycin, clindamycin, and a beta-lactam. Vancomycin will cover for Methicillin-resistant Staphylococcus aureus (MRSA). Your beta-lactam should be effective against Pseudomonas and Streptococcus sp. Examples would include piperacillin-tazobactam or cefepime. Beta-lactams work by lysing the cell wall of bacteria, but this could potentially make things worse with certain organisms that will release toxins. This is where clindamycin comes in and works synergistically with your beta-lactam. Clindamycin acts as a bacteriostatic agent and prevents toxin release. The concept includes a bacteriostatic agent against streptococcus to prevent gas toxin release, while a bactericidal antibiotic does the killing. Patients should get vancomycin for MRSA coverage, a beta-lactam effective against Pseudomonas and streptococcus sp, and clindamycin for its bacteriostatic properties. Linezolid seems like a promising clindamycin/vancomycin sparing alternative. Antibiotics are worthless without source control, and IVIG can be considered for neutralizing streptococcal toxins. Share the three piece PHARMFAX with a friend, give me a follow, and I hope you learned something new.

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Not medical advice. Educational purposes only. No relationships to report. I hope you learned something new.

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