Suspected Necrotising Fasciitis OR Severe Infection in PWID

NHSL Antimicrobial Guidelines
NHS Lanarkshire

Duration

10 days or as per Infection Specialist

Suspected Necrotising Fasciitis or Severe or Rapidly Progressive Infection in Person who Injects Drugs (PWID)

Therapy

  • Seek URGENT Surgical / Orthopaedic review. URGENT DEBRIDEMENT / EXPLORATION maybe required 
  • TAKE blood cultures & COMMENCE empirical antibiotics as per policy 
  • LIAISE with Infection Specialist. 

 

IV Flucloxacillin5, 10 2g 6 hourly 
+ IV Benzylpenicillin 2.4g 4 hourly
+ IV Gentamicin3 
+ Oral / IV Metronidazole12 400mg / 500mg 8 hourly 
+ IV Clindamycin 1.2g 6 hourly

 

True Penicillin allergy or MRSA suspected 

+ IV Vancomycin3 
+ IV Gentamicin3 
+ Oral / IV Metronidazole12 400mg / 500mg 8 hourly 
+ IV Clindamycin 1.2g 6 hourly

Notes:

Total duration: 10 days or as per Infection Specialist

Notes

Doses may need to be adjusted in renal impairment. Always check the BNF for interactions. Seek advice if patient pregnant.

Drug Specific Cautions:

  1. Check interactions in the BNF. Caution may prolong QT interval.
  2. Avoid / Caution in pregnancy or breastfeeding. Consult BNF for details.
  3. Gentamicin/Vancomycin refer to online calculators.
  4. ALERT Antibiotic - Consult Second line Policy on NHS Lanarkshire Guideline App.
  5. Monitor sodium.
  6. See CURB65 definition.
  7. Reference: The Renal Drug Handbook. Online access.
  8. See Fluoroquinolones MHRA guidance on NHS Lanarkshire Guidelines App.
  9. Doxycycline and quinolones decreased absorption with iron, calcium, magnesium and some nutritional supplements. See BNF appendix 1 or pharmacy for advice.
  10. Caution in renal impairment – see BNF or pharmacy for advice.
  11. Use with caution may increase K+ and decrease renal function. Monitor.
  12. High / Excellent oral bioavailability, IV route available for NBM or vomiting.
  13. See Co-trimoxazole information for prescribers’ safety sheet on NHS Lanarkshire Guidelines App.

Editorial Information

Last reviewed: 01/12/2022

Next review date: 01/12/2025

Author(s): NHS Lanarkshire Antimicrobial Management Committee, Dr Dundas, Dr Hylands, S McCormick.

Approved By: NHS Lanarkshire Antimicrobial Management Committee

Reviewer name(s): NHS Lanarkshire Antimicrobial Management Committee.

Document Id: March 2023