Gangrene medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Edzel Lorraine Co, D.M.D., M.D.
Overview
Ischemic gangrene can be medically treated with angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and antiplatelet drugs such as aspirin and clopidogrel. Wet gangrene and gas gangrene are treated with antibiotics which should cover microorganisms detected in culture of the specimen with gangrene. [1]
Medical Therapy
- Ischemic gangrene can be medically treated with angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and antiplatelet drugs such as aspirin and clopidogrel. Wet gangrene and gas gangrene are treated with antibiotics which should cover microorganisms detected in culture of the specimen with gangrene. [1]
- Table 1 lists the possible microorganisms and the suggested antibiotic treatment.
| Microorganism | Treatment |
|---|---|
| Group A Streptococcus | Penicillin plus clindamycin. |
| Clostridium | Penicillin plus clindamycin. |
| Aeromonas hydrophila | Trimethoprim-sulfamethoxazole (TMP-SMX), second and third-generation cephalosporins, fluoroquinolones, carbapenems, tetracyclines, aminoglycosides, and chloramphenicol. [2] [3] [4] [5] [6] [7] [8] |
| Vibrio vulnificus | Third-generation cephalosporin plus tetracycline or fluoroquinolone. [9] |
- Hyperbaric oxygen therapy is one method to address oxygen tension.
- Intravenous immunoglobulin is also an adjunct therapy that inactivates superantigens, responsible for the associated toxic shock syndrome. [10] [11]
References
- ↑ 1.0 1.1 Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL; et al. (2014). "Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America". Clin Infect Dis. 59 (2): 147–59. doi:10.1093/cid/ciu296. PMID 24947530.
- ↑ Janda JM, Abbott SL (1998). "Evolving concepts regarding the genus Aeromonas: an expanding Panorama of species, disease presentations, and unanswered questions". Clin Infect Dis. 27 (2): 332–44. doi:10.1086/514652. PMID 9709884.
- ↑ Motyl MR, McKinley G, Janda JM (1985). "In vitro susceptibilities of Aeromonas hydrophila, Aeromonas sobria, and Aeromonas caviae to 22 antimicrobial agents". Antimicrob Agents Chemother. 28 (1): 151–3. doi:10.1128/AAC.28.1.151. PMC 176330. PMID 4037775.
- ↑ Overman TL, Janda JM (1999). "Antimicrobial susceptibility patterns of Aeromonas jandaei, A. schubertii, A. trota, and A. veronii biotype veronii". J Clin Microbiol. 37 (3): 706–8. doi:10.1128/JCM.37.3.706-708.1999. PMC 84530. PMID 9986836.
- ↑ Vila J, Marco F, Soler L, Chacon M, Figueras MJ (2002). "In vitro antimicrobial susceptibility of clinical isolates of Aeromonas caviae, Aeromonas hydrophila and Aeromonas veronii biotype sobria". J Antimicrob Chemother. 49 (4): 701–2. doi:10.1093/jac/49.4.701. PMID 11909850.
- ↑ Cattoir V, Poirel L, Aubert C, Soussy CJ, Nordmann P (2008). "Unexpected occurrence of plasmid-mediated quinolone resistance determinants in environmental Aeromonas spp". Emerg Infect Dis. 14 (2): 231–7. doi:10.3201/eid1402.070677. PMC 2600179. PMID 18258115.
- ↑ Sánchez-Céspedes J, Figueras MJ, Aspiroz C, Aldea MJ, Toledo M, Alperí A; et al. (2009). "Development of imipenem resistance in an Aeromonas veronii biovar sobria clinical isolate recovered from a patient with cholangitis". J Med Microbiol. 58 (Pt 4): 451–455. doi:10.1099/jmm.0.47804-0. PMID 19273640.
- ↑ Aravena-Román M, Inglis TJ, Henderson B, Riley TV, Chang BJ (2012). "Antimicrobial susceptibilities of Aeromonas strains isolated from clinical and environmental sources to 26 antimicrobial agents". Antimicrob Agents Chemother. 56 (2): 1110–2. doi:10.1128/AAC.05387-11. PMC 3264277. PMID 22123695.
- ↑ Dechet AM, Yu PA, Koram N, Painter J (2008). "Nonfoodborne Vibrio infections: an important cause of morbidity and mortality in the United States, 1997-2006". Clin Infect Dis. 46 (7): 970–6. doi:10.1086/529148. PMID 18444811.
- ↑ Linnér A, Darenberg J, Sjölin J, Henriques-Normark B, Norrby-Teglund A (2014). "Clinical efficacy of polyspecific intravenous immunoglobulin therapy in patients with streptococcal toxic shock syndrome: a comparative observational study". Clin Infect Dis. 59 (6): 851–7. doi:10.1093/cid/ciu449. PMID 24928291.
- ↑ Darenberg J, Söderquist B, Normark BH, Norrby-Teglund A (2004). "Differences in potency of intravenous polyspecific immunoglobulin G against streptococcal and staphylococcal superantigens: implications for therapy of toxic shock syndrome". Clin Infect Dis. 38 (6): 836–42. doi:10.1086/381979. PMID 14999628.