Gas gangrene medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Gas gangrene is a medical emergency. Therapy for gas gangrene involves a combined surgical and medical approach. Empiric therapy for gas gangrene includes a combination of Vancomycin and either Piperacillin-tazobactam, Ampicillin-sulbactam, or a Carbapenem. Currently, targeted therapy with a combination of Penicillin G and Clindamycin remains the most effective and preferred treatment.

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 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]

• 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

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