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Necrotizing Fasciitis Caused by Group A Streptococcus: Case Report and Therapy Update

Florida A &M University, College of Pharmacy and Pharmaceutical Sciences, Miami Division; and Clinical Pharmacy Specialist, Surgical Intensive Care, Department of Pharmacy, Veterans Affairs Medical Center, Miami, Florida, mlarosepierre{at}yahoo.com

John J. Scrivens, Jr., RPh, PhD

Florida A &M University, College of Pharmacy and Pharmaceutical Sciences, Tampa Bay Division, Tampa, Florida, Scrivens_J{at}popmail.firn.edu

Daryl Norwood, PharmD

Pharmacy Practice, Florida A &M University, College of Pharmacy and Pharmaceutical Sciences, Miami Division, Miami, Florida, darylnorwood{at}hotmail.com

Leonard Rappa, PharmD

Pharmacy Practice, Florida A & M University, College of Pharmacy and Pharmaceutical Sciences, Miami Division, Miami, Florida, rxpsych{at}yahoo.com

Necrotizing fasciitis is a life-threatening infection that affects the fascia and fat tissue underlying the skin. The diagnosis is often difficult because subcutaneous changes may not be readily apparent. Toxin-producing bacteria are usually the cause, with group A streptococcus (GAS) or Streptococcus pyogenes being responsible for a significant portion of the morbidity and mortality associated with this infection. The mortality rate associated with necrotizing fasciitis varies between 30% and 60%. Toxic shock-like syndrome and multisystem organ failure are the usual causes of death. Early diagnosis and surgery have been associated with decreased morbidity and mortality, and appropriate antimicrobial (eg, penicillin plus clindamycin) and supportive therapy is of utmost importance. Intravenous immunoglobulin and hyperbaric oxygen therapy may be beneficial in treating the infection; however, these 2 therapies require further research. Clinicians need to familiarize themselves with the disease and the different treatment modalities to be able to make the appropriate therapeutic decision. The optimal treatment of necrotizing fasciitis still remains a challenge today. This article presents an illustrative case with a brief overview of necrotizing fasciitis, and the current therapeutic modalities used in the management of the disease.

Key Words: necrotizing fasciitis • group A streptococcus • toxic shock-like syndrome

Journal of Pharmacy Practice, Vol. 15, No. 3, 290-296 (2002)
DOI: 10.1106/BWR9-M77Y-PQCV


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