If a necrotizing soft tissue infection is considered, therapy mandates:

a. Empiric administration of antibiotics active against gram-positive, gram-negative, and anaerobic bacteria

c. Immediate operative intervention and aggressive resection of all involved tissues is mandatory

Identification of a necrotizing, soft tissue infection mandates immediate operative intervention with aggressive resection of all involved tissues and empiric administration of antibiotics active against gram-positive, gram-negative, and anaerobic bacteria. In most cases, this involves the use of several antimicrobial antibiotics in combination. Because of concern in all cases for the presence of Clostridia infection, high doses of aqueous penicillin G are administered. Gram-positive organisms are treated with vancomycin or a semisynthetic penicillin and gram-negative organisms are treated with an aminoglycoside or a monobactam. Anaerobic coverage is typically achieved by use of metronidazole of clindamycin. The use of hyperbaric oxygen therapy is controversial and unfortunately due to the rarity of the disease, prospective randomized data is not available so that the literature remains without controlled trials demonstrating any additional benefits derived from hyperbaric oxygen therapy.