Modification and duration of therapy for necrotising skin and soft tissue infection

Modification of therapy: modify therapy for necrotising skin and soft tissue infection based on the results of Gram stain, culture and susceptibility testing of a surgical deep tissue sample. See the regimens for infections caused by:

• Streptococcus pyogenes
• clostridial
• methicillin-resistant Staphylococcus aureus (MRSA).

If other species (eg Vibrio vulnificus, Aeromonas hydrophila) are identified on Gram stain, culture and susceptibility tests, seek expert advice.

Duration of therapy: switch to oral antibiotic therapy when further debridement is no longer necessary, there has been clinical improvement, and the patient has been afebrile for 48 to 72 hoursStevens, 2014. The choice of oral therapy should be guided by the microbiological diagnosis or expert advice. Continue oral therapy until the infection has resolved, but not necessarily until the wound has healed.