What is the role of antibiotic and antifungal therapy for Fournier gangrene?

Updated: Jun 03, 2021
  • Author: Vernon M Pais, Jr, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Treatment of Fournier gangrene involves the institution of broad-spectrum antibiotic therapy. The antibiotic spectrum should cover staphylococci, streptococci, the Enterobacteriaceae family of organisms, and anaerobes.

A reasonable empiric regimen might consist of ciprofloxacin and clindamycin. Clindamycin is particularly useful in the treatment of necrotizing soft-tissue infections because of its gram-positive and anaerobic spectrum of activity. In animal models of streptococcal infection, clindamycin has been shown to yield response rates superior to those of penicillin or erythromycin, even in the context of delayed treatment. [68]

Other possible choices include ampicillin/sulbactam, ticarcillin/clavulanate, or piperacillin/tazobactam in combination with an aminoglycoside and metronidazole or clindamycin. Vancomycin can be used to provide coverage for methicillin-resistant Staphylococcus aureus (MRSA).

In cases associated with sepsis syndrome, therapy with intravenous immunoglobulin (IVIG), which is thought to neutralize superantigens (eg, streptotoxins A and B) believed to mitigate the exaggerated cytokine response, has been shown to be a good adjuvant to appropriate antibiotic coverage and complete surgical debridement. [69]

If initial tissue stains (ie, potassium hydroxide [KOH] stain) show fungi, add an empiric antifungal agent such as amphotericin B or caspofungin.


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