Necrotizing Fasciitis (Flesh-Eating Bacteria): Treatment Overview

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Treatment Overview

A person with necrotizing fasciitis needs immediate medical treatment in a hospital as soon as the condition is suspected. Admission to the intensive care unit (ICU) is usually required.

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

Treatment focuses on:

• Fighting the infection and its spread using surgery to remove infected fluid and tissue.
• Medications (antibiotics and intravenous immunoglobulin) to kill the bacteria causing the infection.
• Hyperbaric oxygen therapy, in some cases.
• Treating complications such as shock, respiratory problems, and organ failure.

Surgery

Surgery (surgical debridement) is almost always necessary to remove the infected dead tissue resulting from necrotizing fasciitis, reduce the number of bacteria present 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 commonly given to kill certain strains of bacteria that often cause necrotizing fasciitis (such as streptococci and staphylococci) and stop the production of bacterial toxins that cause the illness. A combination of antibiotics (broad-spectrum therapy) may be needed when other types of bacteria are present (for example, when people with diabetes or people already in the hospital for another condition develop necrotizing fasciitis).

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 and reduce the need for surgery.^{4, 2} However, more studies are needed before this type of treatment can be recommended for people who have necrotizing fasciitis.

Treatment for complications

The kind of treatment needed will depend on how the illness is progressing and what other problems it has caused.

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 require use of a kidney machine (hemodialysis) to treat kidney failure, and about one-half will need help breathing using a ventilator machine until their condition improves.

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Last updated:	November 01, 2005
Author:	Colleen Cronin
Reviewed By:	Renée M. Crichlow, MD - Family Medicine, Dennis L. Stevens, MD, PhD - Internal Medicine, Infectious Diseases
Editors:	Susan Van Houten, RN, BSN, MBA, Lisa Shaw