壊死性筋膜炎
忘れた頃に出会ってしまう、壊死性筋膜炎。
連鎖球菌毒性ショックやっかいです。
今回は、主治医と協議し以下の投与法になりました。 投与期間は、フォーカルサイン確認しつつ、14ー21日想定。
- 手術室で緊急デブリ
- PCG2400 持続投与
(PCG 1200 + 1号500mL 12hr) x 2
- CLDM 600 x 3
UpToDate より
Management of streptococcal toxic shock syndrome (TSS) includes treatment of septic shock and associated complications, surgical debridement of infection (if feasible), and antimicrobial therapy. Early aggressive surgical intervention is critical.
Empiric antimicrobial therapy should be initiated pending culture results; thereafter, antimicrobial therapy should be tailored accordingly. We recommend an empiric regimen consisting of clindamycin plus either a carbapenem or combination drug containing a penicillin plus beta-lactamase inhibitor (Grade 1B).
Once a diagnosis of streptococcal TSS is established, we recommend treatment with clindamycin (900 mg intravenously [IV] every eight hours) in addition to penicillin G (4 million units IV every four hours) (Grade 1B). The duration of antibiotic therapy depends on individual patient circumstances.
For patients with streptococcal TSS, we suggest administration of intravenous immune globulin (Grade 2B).
Dosing consists of 1 g/kg day 1, followed by 0.5 g/kg on days 2 and 3.
Duration of therapy
There are no clinical studies addressing the optimal duration of antibiotic therapy in streptococcal TSS; the duration of antibiotic therapy should be individualized. Patients with bacteremia should be treated for at least 14 days. In patients with complicating deep-seated infections, such as necrotizing fasciitis, length of therapy depends on the clinical course and the adequacy of surgical debridement; therapy is usually continued for 14 days from the last positive culture obtained during surgical debridement.