infectious diseases
Clostridial Soft Tissue Infections
Treatment of Clostridial Soft Tissue Infections
Drainage and debridement Penicillin plusclindamycin When clinical signs of clostridial infection (eg, gas, myonecrosis) are present, rapid, aggressive intervention is mandatory. Thorough drainage and debridement are as important as antibiotics; both should be instituted rapidly. Penicillin G3 to 4 million units IV every 4 to 6 hours andclindamycin600 to 900 mg IV every 6 to 8 hours (which inhibits toxin production) should be given immediately for severe cellulitis and myonecrosis.Clindamycinalone is inadequate. If gram-negative organisms are seen or suspected, a broad-spectrum antibiotic (eg,piperacillin/tazobactamor a carbapenem) should be used withclindamycin. If penicillin-allergic patients have a life-threatening clostridial infection,clindamycinwithmetronidazolemay be used; if other organisms are present, a non–beta-lactam broad-spectrum antibiotic such as a fluoroquinolone oraztreonamshould be added along withvancomycinforStaphylococcus aureus. Hyperbaric oxygen therapy may be helpful in extensive myonecrosis, particularly in the extremities, as a supplement to antibiotics and surgery. Hyperbaric oxygen therapy may salvage tissue and lessen mortality and morbidity if it is started early,but it should not delay surgical debridement. 