Modification and duration of therapy for Streptococcus pyogenes necrotising fasciitis

For S. pyogenes necrotising fasciitis, continue intravenous benzylpenicillin or cefazolin until further debridement is no longer necessary, there has been clinical improvement, and the patient has been afebrile for 48 to 72 hours. Once these criteria are met, switch to oral amoxicillin and stop clindamycin (intravenous or oral). Use:

Continue oral amoxicillin until the infection has resolved, but not necessarily until the wound has healed.

For advice on choosing an oral agent for patients who have had a hypersensitivity reaction to a penicillin, seek expert advice.