Which antibiotics are recommended in the treatment of mixed necrotizing infections?

Updated: Jun 14, 2019
  • Author: Thomas E Herchline, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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The IDSA recommends IV clindamycin and penicillin therapy for severe group A streptococcal and clostridial necrotizing infections. [2] For mixed necrotizing infections, in which gas in deep tissues is a frequent finding, select antimicrobials with efficacy against aerobic gram-positive/gram-negative organisms and anaerobes.

The IDSA recommends the following as first-line antibiotic treatments in managing adult mixed necrotizing infections [2] :

  • Ampicillin-sulbactam 1.5-3.0 g IV q6-8h (for patients with severe penicillin hypersensitivity: clindamycin or metronidazole plus an aminoglycoside or fluoroquinolone; add an appropriate agent in the presence of [or if there is a suspicion of] staphylococcal infection) or  piperacillin-tazobactam 3.37 g IV q6-8h plus  clindamycin 600-900 mg/kg IV q8h plus ciprofloxacin 400 mg IV q12h

  • Imipenem-cilastatin 1 g IV q6-8h

  • Meropenem 1 g IV q8h

  • Ertapenem 1 g IV qd

  • Cefotaxime 2 g IV q6h plus  metronidazole 500 mg IV q6h or clindamycin 600-900 mg/kg IV q8h

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