A few things to remember about treating necrotizing soft tissue infections:
Often polymicrobial and most of the time we in the ED won't have a microbial diagnosis
If due to strep, patient may benefit from the addition of Clindamycin. Streptococcal species may stop multiplying in a wound/cellulitis and continue to produce large amounts of tissue toxin. In this case, many antibiotics (like the ubiquitous Zosyn-which works on dividing bacteria) may not work well. Clindamycin will actually affect toxin binding. The phenomenon of Strep species dividing but continuing to produce toxin is referred to as the Eagle affect.
So, when shot-gunning the antibiotics in a patient with a really bad soft tissue infection (not the run of the mill cellulitis) consider adding Clindamycin to the regimen.
