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please respond to the following discussion post at the end of the instructions. Please use your in text citation and also reference according to the APA guidelines. Use your own words, do not use direct quotes on this order. Use scholarly peer reviewed references within the last 5 years to support your response. please avoid using consumer level resources such as drugs. com or mayoclinic.com. please use the appropriate sources this is professional level course. respond the following discussion board post using peer reviewed scholarly sources to support your answer. S. H. Necrotizing soft tissue infections are clinically characterized by severe and sudden tissue destruction, systemic signs of toxicity, and high mortality (Stevens & Baddour, 2022). Necrotizing fasciitis involves the deep soft tissues leading to “progressive destruction of the muscle fascia and overlying subcutaneous fat” (Stevens & Baddour, 2022, sect. 3). There are two types of necrotizing fasciitis- polymicrobial (type I) and monomicrobial (type II) (Stevens & Baddour, 2022). Type I is typically caused by aerobic and anaerobic bacteria and normally occurs in older adults or in those with comorbidities like diabetes and peripheral vascular disease (Stevens & Baddour, 2022). Type 2 is commonly caused by Group A Streptococci (GAS) and can occur in any individual (Stevens & Baddour, 2022). Prompt diagnosis, immediate antibiotic therapy, and early surgical exploration, in order to confirm necrotizing infection, assess the extent of it, and to debride the tissue, is required (Stevens & Baddour, 2022). The purpose of this discussion is to evaluate pharmaceutical management of a 45-year-old male admitted with an acute presentation of necrotizing fasciitis.
Antibiotic coverage should not be delayed while waiting for cultures to result. Common organisms of necrotizing fasciitis include Streptococci species (gram positive bacteria), Bacteroides (anaerobic gram-negative bacilli), Staphylococcus species (gram-positive bacteria), Clostridium species (anaerobic bacteria), and Enterococcus species (gram-positive bacteria) (Levine, 2020; Hauser, 2019). Although there are a few acceptable regimens, one may include Imipenem 1g IV three times daily, Vancomycin 15 mg/kg IV every six to eight hours, as well as Clindamycin 600 to 900 mg IV every 8 hours (Stevens & Baddour, 2022). Imipenem is a carbapenem that is active against many gram positive, gram negative, and anaerobic bacteria (Hauser, 2019). Vancomycin is a glycopeptide that is active against gram positive organisms (nearly all staphylococci, including methicillin-resistant S. aureus (MRSA) and streptococci, and some enterococci) (Hauser, 2019). Clindamycin is a lincosamide that is active against aerobic gram-positive and anaerobic bacteria (Hauser, 2019). Clindamycin is used especially for its actions on inhibiting toxin production in cases where Group A Streptococcus is suspected (Levine, 2020). This empiric antibiotic treatment plan is comprised of coverage for gram-positive, gram-negative, and anaerobic organisms (Stevens & Baddour, 2022). Adjustments to this regimen can be made once gram stain, culture, and sensitivity results become available.