Early and aggressive surgical debridement of all necrotic tissue is essential.
Pain out of proportion
Systemic signs of sepsis and organ dysfunction
Signs of deeper infection (skin sloughing, bullae)
Profound systemic toxicity
Advancement of infection during antibiotic therapy
Presence of gas
(Group A β-hemolytic streptococci)
Treat as severe, non-purulent SSTI until C&S confirmation
Treatment of Severe SSTI
Penicillin G Dosing
Intravenous treatment until further debridement no longer necessary and has improved clinically and fever has been absent for 48–72 hours.
Stepdown and total duration of therapy based on clinical progression.