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Are there any reasons to change our behavior in necrotizing fasciitis with the advent of new antibiotics?

Menichetti, Francesco; Giuliano, Simone; Fortunato, Simona

Current Opinion in Infectious Diseases: April 2017 - Volume 30 - Issue 2 - p 172–179
doi: 10.1097/QCO.0000000000000359
SKIN AND SOFT TISSUE INFECTIONS: Edited by Matteo Bassetti

Purpose of review: The treatment of necrotizing fasciitis requires a multifaceted approach, consisting of surgical source control with immediate surgical debridement along with life support, clinical monitoring, and antimicrobial therapy. Many drugs are now available for the treatment of this life-threatening infectious disease, and the purpose of this review is to provide the reader with an updated overview of the newest therapeutic options.

Recent findings: Because most necrotizing soft tissue infections are polymicrobial, broad-spectrum coverage is advisable. Acceptable monotherapy regimens include piperacillin-tazobactam or a carbapenem. However, drugs such as ceftolozane–tazobactam, ceftazidime–avibactam in association with an antianaerobic agent (metronidazole or clindamycin) are currently available as valuable alternatives. The new cephalosporins active against methicillin-resistant Staphylococcus aureus (MRSA), ceftaroline, and ceftobiprole share similar antibacterial activity against Gram-positive cocci, and they might be considered as an alternative to nonbetalactam anti-MRSA agents for necrotizing fasciitis management. Two new long-acting lypoglycopeptides – oritavancin and dalbavancin – share the indications for acute bacterial skin and skin structure infections and had similar activity against Gram-positive cocci including MRSA and streptococci.

Summary: Carbapenem-sparing agents are particularly suitable for antimicrobial stewardship strategy. The new long-acting lypoglycopeptides are very effective in treating necrotizing fasciitis and are uttermost attractive for patients requiring short hospital stays and early discharge.

Infectious Disease Unit, Cisanello Hospital, Pisa, Italy

Correspondence to Prof Francesco Menichetti, Infectious Disease Unit, Cisanello Hospital, Pisa, Italy. E-mail: menichettifrancesco@gmail.com

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