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Table 4 Suggested potential antibiotics therapeutic regimens depending on pathogens organisms, clinical conditions, predisposing factors, and antimicrobial choices

From: Necrotizing fasciitis: literature review of contemporary strategies for diagnosing and management with three case reports: torso, abdominal wall, upper and lower limbs

Pathogens and clinical condition Predisposing factors Antimicrobial choices
Gram-positive organisms   
Group A streptococcus (S. pyogenes)
Erysipelas
Minor skin trauma or skin break penicillins or cephalosporins, or alternative therapy: clindamycin, macrolides, glycopeptidescephalosporins, semi-synthetic resistant penicillin or
Cellulitis Minor skin trauma or break alternative therapy: clindamycin, macrolides, glycopeptides
Necrotizing fasciitis with/without myonecrosis Minor skin trauma or skin break, superinfection of varicella lesion, DM, non-steroid anti-inflammatory drugs high dose penicillin G, clindamycin or alternative therapy: clindamycin
Group β streptococcus (S. agalactiae)
Necrotizing fasciitis
DM, premature neonates high dose penicillin G, clindamycin or alternative therapy: clindamycin
Community-acquired meticillin resistant; Staphilococcus aureus (CO-MRSA) No specific risk factors glycopeptides or clindamycin, or alternative therapy: linezolidin, sulfomethoxazole, clindamycin
  Nasocomial MRSA in health care facilities is the major risk factor high dose penicillin G, clindamycin or alternative therapy: clindamycin, metronidazole
Clostridium spp Gross tidy and contaminated wounds  
  (C. perfrigens)  
  Colonic contamination (C. septicum)  
  IV drug use (C sordellil, C nayvi)  
Gram-negative organisms   
Pasteurella spp Dog bites (P canis)
Cat bites (P multocida)
amoxicillin, clavulanate piperacillin, tazobactam, III-generation cephalosporin metronidasole or alternative therapy: clindamycin, flouroquinolone, trimoxasole
Aeromonas spp (A. hydrophilia) Freshwater exposure, medical leeches fluoroquinolones or alternative therapy: trimoxasole, cephalsporins, aminolgycosides
Vibrio spp (V. vulnificus) Chronic liver disease, DM minocycline, cephalosporine or alternative therapy: ciprofloxacin
Klebsiella pneumonia Chronic liver disease, DM cephalosporines, amoxicillin, carbapenems, flouroquinolones, or alternative therapy: amynoglycosides
Escherichia coli Cirrhosis cephalosporines, amoxicillin, carbapenems, flouroquinolones, or alternative therapy: amynoglycosides
Serratia marcescens Chronic renal failure, DM cephalosporines, amoxicillin, piperacillin, tazobactam, carbapenems, flouroquinolones, or alternative therapy: amynoglycosides
Pseudomonas aeruginosa Neutropenia, haematological malignancy, burns, HIV infection, injection drug use amoxicilin, aminoglycosides, or alternative therapy: flouroquinolones