101. Necrotizing fasciitis

หญิง 53 ปี Underlying HT, AF ปวดบวมแดงขาขวามา 3 วัน Dx?, Mx?

Treatment •Aggressively treat the patient with suspected necrotizing fasciitis to reduce morbidity and mortality [overall morbidity and mortality is 70-80%]
•Early surgical consultation for aggressive debridement
•Streptococci are major pathogens, the drug of choice is penicillin G, with clindamycin as the alternative. To ensure adequate treatment, there must be coverage for aerobic and anaerobic bacteria. The anaerobic coverage can be provided by metronidazole or third-generation cephalosporins. Gentamicin, combined with clindamycin or chloramphenicol, has been proposed as a standard coverage. Ampicillin may be added to the basic regimen to treat enterococci if suspected by Gram stain

http://emedicine.medscape.com/article/784690-overview