This handout is for necrotizing soft-tissue infection. Your care team identified this based on: pain out of proportion to exam findings (hallmark) (idsa 2014).
Other reasons your team may use this plan: cellulitis with rapid spread, systemic toxicity, hemorrhagic bullae (idsa 2014); crepitus / gas in soft tissue / dishwater discharge from incision (idsa 2014); perineal / scrotal pain + skin necrosis (fournier gangrene) (idsa 2014).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| vancomycin | 25-30 mg/kg IV loading then 15-20 mg/kg q8-12h (target AUC 400-600 or trough 15-20) | IV | q8-12h | MRSA coverage (Class I IDSA 2014); pair with pip-tazo + clinda for full empiric (PMID 24973422) |
| piperacillin_tazobactam | 4.5 g IV q6h (or 3.375 g q6h; extended-infusion 4h preferred in severe sepsis) | IV | q6h | Broad gram-neg + anaerobic + Pseudomonas (Class I IDSA 2014 PMID 24973422) |
| clindamycin | 900 mg IV q8h | IV | q8h | Suppresses Group A Strep toxin (Eagle effect — works at high inoculum where beta-lactams fail); Class I IDSA 2014 for NSTI / strep TSS (PMID 24973422) |
| meropenem | 1 g IV q8h | IV | q8h | Alternative to pip-tazo when penicillin allergy / ESBL risk; pair with vanc + clinda (IDSA 2014) |
| linezolid | 600 mg IV q12h | IV | q12h | Alternative MRSA agent when vanc contraindicated; suppresses staph toxin (similar to clinda); IDSA 2014 (PMID 24973422) |
| daptomycin | 6-8 mg/kg IV daily (NOT for lung infection) | IV | daily | Alternative MRSA agent for soft tissue when vanc fails / not tolerated (IDSA 2014); inactivated by surfactant — no pulmonary coverage |
Plan: NSTI — empiric broad-spectrum antibiotics + surgical source control (IDSA 2014)
Call 911 or go to the nearest emergency room right away if you have:
Wound care, skin grafting / reconstruction planning, PT/OT, prosthetics if amputation, infectious disease follow-up; total antibiotic course 2-4 weeks depending on source control (IDSA 2014)
Guideline: IDSA 2014 Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections (Stevens) — covers necrotizing infections, gas gangrene, Fournier, Vibrio