Gas gangrene medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Any significantly massive infection is a medical emergency. In cases of gangrene, the infection is so severe by the time that a diagnosis is made that countering the bacterial load is impossible even with the strongest available antibiotics, for example gentamycin and vancomycin. Antibiotics alone are not effective because they don't penetrate ischemic muscles enough to be effective. There are two major reasons for this; current antibiotics only prevent replication of bacteria and the production of toxins continues in pre-existing bacteria. Also, the extent of injury caused by the infection may leave the muscle tissues so damaged that the body will never be able to replace the lost structures (including vasculature).
Currently, the use of penicillin G and clindamycin combination remains the most effective and preferred treatment.[1]
Medical Therapy
Antimicrobial regimen
- Gas gangrene[2]
- 1. Empiric antimicrobial therapy
- Preferred regimen (1): Vancomycin 1 g IV q12h AND (Piperacillin-tazobactam 3.375 g q6h
- Preferred regimen (2): Vancomycin 1 g IV q12h AND Ampicillin-sulbactam 3 g IV q6h
- Preferred regimen (2): Vancomycin 1 g IV q12h AND Carbapenem)
- 2. Culture directed antimicrobial therapy
- 2.1 Clostridium perfringens
- Preferred regimen: Penicillin G 24 MU/day IV q4-6h AND Clindamycin 900 mg IV q8h
- Alternative regimen (1): Erythromycin 1 g IV q6h
- Alternative regimen (2): Ceftriaxone 2 g IV q12h
References
- ↑ Stevens, DL.; Bisno, AL.; Chambers, HF.; Everett, ED.; Dellinger, P.; Goldstein, EJ.; Gorbach, SL.; Hirschmann, JV.; Kaplan, EL. (2005). "Practice guidelines for the diagnosis and management of skin and soft-tissue infections". Clin Infect Dis. 41 (10): 1373–406. doi:10.1086/497143. PMID 16231249. Unknown parameter
|month=ignored (help) - ↑ Gilbert, David (2015). The Sanford guide to antimicrobial therapy. Sperryville, Va: Antimicrobial Therapy. ISBN 978-1930808843.