Necrotizing Fasciitis (Flesh-Eating Bacteria)

Treatment Overview

A person with necrotizing fasciitis needs to go to the hospital for treatment as soon as the condition is suspected. The person will usually be treated in the intensive care unit (ICU).

Early treatment of necrotizing fasciitis is critical. The sooner treatment begins, the more likely the person will recover from the infection and avoid serious consequences, such as limb amputation or death.

Treatment may include:

• Surgery that removes infected tissue and fluids to stop the spread of infection.
• Medicines (antibiotics and intravenous immunoglobulin) to kill the bacteria causing the infection.
• Procedures to treat complications such as shock, respiratory problems, and organ failure.
• Hyperbaric oxygen therapy, which can help prevent tissue death and promote healing.

Surgery

Surgery (surgical debridement) is almost always needed to remove the infected dead tissue resulting from necrotizing fasciitis. This can also reduce the number of bacteria in the body, remove toxins, and stop the spread of infection. Most people need several operations to fully control the infection.

Removing limbs (amputation) or organs may be necessary to save the person's life, depending on how severe the infection is and where it has spread.

Medications

Intravenous (IV) antibiotics such as clindamycin and penicillin are used to kill some kinds of bacteria that can cause necrotizing fasciitis (usually streptococci and staphylococci) and stop the production of toxins that cause the illness. More than one antibiotic (broad-spectrum therapy) may be needed, especially when the person has diabetes or injury to the intestines.

Intravenous immunoglobulin (IVIG) may be used along with surgery and antibiotics to help treat necrotizing fasciitis. IVIG boosts the body's immune system and reduces the effects of bacterial toxins. It is not yet clear whether treatment with IVIG helps cure necrotizing fasciitis.

Oxygen therapy

Hyperbaric oxygen therapy, which provides your body with high levels of oxygen, may help control infection, promote healing, and reduce the need for surgery.^{4, 5} For this treatment, the person with necrotizing fasciitis is placed in a chamber and the air in the chamber is enriched with oxygen. Hyperbaric oxygen therapy is not routinely done to treat necrotizing fasciitis.

Treatment for complications

Other types of treatment for complications caused by necrotizing fasciitis may be needed. The kind of treatment depends on what part of the body is affected and what problems the infection is causing.

Shock, kidney failure, and breathing problems caused by damage to the lungs (respiratory distress syndrome) are the most common complications of necrotizing fasciitis. Many people who develop necrotizing fasciitis will need dialysis to treat kidney failure, and about one-half will need a machine (ventilator) to help with breathing until their health improves.

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Author:	Maria G. Essig, MS, ELS Ralph Poore	Last Updated: December 6, 2007
Medical Review:	E. Gregory Thompson, MD - Internal Medicine Dennis L. Stevens, MD, PhD - Internal Medicine, Infectious Diseases Donald Sproule, MD, CM, CCFP, FCFP - Family Medicine
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