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terial skin infections
Necrotising infections of the skin and soft tissue
N ecrosis of the hyp od erm is, w ith a vascular throm bosis, an d som etim es a n ecrosis of
th e un d erlyin g sup erficial ap on eurosis ( fasciitis) an d secon d arily n ecrosis of th e
d erm is. T he clin ical p icture varies d ep en d in g on the causal bacteria, m ost often G roup
A strep tococcus, com m on ly associated w ith oth er bacteria ( Staphylococcus aureus,
an aerobic, en terobacteria, en terococcus).
Clinical features
I n ten sely p ain ful, p oorly d em arcated , eryth em atous p laq ue w ith oed em a an d severe
sep tic syn d rom e. S om e p atien ts th en d evelop h em orrh agic blisters an d bluish or
black ish, cold , hyp oaesthetic sp ots. T he p resen ce of gas or crep itation on p alp ation is
lin k ed to certain bacteria (Clostridium perfringens, en terobacteria).
Treatment
In case of n ecrotisin g fasciitis or gas gan gren e: refer.
– U rgen t surgical d rain age of the w oun d an d excision of the n ecrotic tissue.
– A n tibiotic treatm en t ( th e len gth of treatm en t varies accord in g to th e clin ical
evolution ):
• Necrotising fasciitis:
benzylpenicillin I V
C hild ren : 6 0 0 0 0 0 I U ( 3 6 0 m g) / k g/ d ay in 6 in jection s or in fusion s given
every
4 hours
A d ults: 2 4 M I U (1 4 .4 g)/ d ay in 6 in jection s or in fusion s given every 4 hours
c+lindamycin IV
C hild ren : 4 0 m g/ k g/ d ay in 3 in fusion s given every 8 hours (m axim um 1 .3 g/ d ay)
A d ults: 1 .8 g/ d ay in 3 in fusion s given every 8 hours
• Gbaenszgyalpnegnriceinllein: I V : as above
m+ etronidazole I V
C hild ren : 3 0 m g/ k g/ d ay in 3 in fusion s given every 8 hours (m axim um 1 .5 g/ d ay)
A d ults: 1 .5 g/ d ay in 3 in fusion s given every 8 hours
g+entamicin I M
C hild ren an d ad ults: 3 to 6 m g/ k g/ d ay in 2 in jection s
108
Necrotising infections of the skin and soft tissue
N ecrosis of the hyp od erm is, w ith a vascular throm bosis, an d som etim es a n ecrosis of
th e un d erlyin g sup erficial ap on eurosis ( fasciitis) an d secon d arily n ecrosis of th e
d erm is. T he clin ical p icture varies d ep en d in g on the causal bacteria, m ost often G roup
A strep tococcus, com m on ly associated w ith oth er bacteria ( Staphylococcus aureus,
an aerobic, en terobacteria, en terococcus).
Clinical features
I n ten sely p ain ful, p oorly d em arcated , eryth em atous p laq ue w ith oed em a an d severe
sep tic syn d rom e. S om e p atien ts th en d evelop h em orrh agic blisters an d bluish or
black ish, cold , hyp oaesthetic sp ots. T he p resen ce of gas or crep itation on p alp ation is
lin k ed to certain bacteria (Clostridium perfringens, en terobacteria).
Treatment
In case of n ecrotisin g fasciitis or gas gan gren e: refer.
– U rgen t surgical d rain age of the w oun d an d excision of the n ecrotic tissue.
– A n tibiotic treatm en t ( th e len gth of treatm en t varies accord in g to th e clin ical
evolution ):
• Necrotising fasciitis:
benzylpenicillin I V
C hild ren : 6 0 0 0 0 0 I U ( 3 6 0 m g) / k g/ d ay in 6 in jection s or in fusion s given
every
4 hours
A d ults: 2 4 M I U (1 4 .4 g)/ d ay in 6 in jection s or in fusion s given every 4 hours
c+lindamycin IV
C hild ren : 4 0 m g/ k g/ d ay in 3 in fusion s given every 8 hours (m axim um 1 .3 g/ d ay)
A d ults: 1 .8 g/ d ay in 3 in fusion s given every 8 hours
• Gbaenszgyalpnegnriceinllein: I V : as above
m+ etronidazole I V
C hild ren : 3 0 m g/ k g/ d ay in 3 in fusion s given every 8 hours (m axim um 1 .5 g/ d ay)
A d ults: 1 .5 g/ d ay in 3 in fusion s given every 8 hours
g+entamicin I M
C hild ren an d ad ults: 3 to 6 m g/ k g/ d ay in 2 in jection s
108
