BioAcyl Corp

Suggested antibiotic treatment for necrotizing soft tissue infection (NSTI) and future perspectives. The mainstem of empiric treatment is a broad-spectrum beta-lactam (e.g., piperacillin-tazobactam) with additional aminoglycosides in case of septic shock. Clindamycin should be added in case of documented or suspected group A streptococcus (GAS) infection (limb infection, features of streptococcal toxic shock, absence of comorbidities, blunt trauma, absence of chronic skin lesions, homelessness, injectable drug use, non-steroidal anti-inflammatory drug use). Coverage of resistant gram-negative bacilli by carbapenems should be used according to local ecology and individual risk factors (hospital acquired infection, beta-lactam, or quinolone exposure in the previous 3 months, history of extended spectrum beta-lactamase (ESBL) carrying, germ colonization/infection or travel to high ESBL endemicity aeras in the previous 3 months). Similarly, use of anti-methicillin resistant Staphylococcus aureus (MRSA) drugs such as vancomycin, linezolid, or daptomycin should be considered in case of local endemicity, residence in a long-stay care facility, chronic dialysis, permanent transcutaneous medical devices or prior MRSA infection/colonization. Pharmacokinetics (PK) and Pharmacodynamics (PD) should be optimized by use of high-loading doses and prolonged infusions for molecules with time-dependent bactericidal activity such as beta-lactams, and therapeutic drug monitoring should be used when available.