Although imaging with magnetic resonance induction and computed tomography scanning have been noted to be of value in diagnosing necrotizing fasciitis, surgical management should not be unduly delayed in favour of these. Most authorities in Canada recommend prophylaxis with drugs such as penicillin, amoxicillin, first generation cephalosporins, clindamycin or erythromycin for 10 days. However, definitive studies of chemoprophylaxis remain to be done. There is no role for doing throat cultures to determine if the contacts require chemoprophylaxis because a negative culture does not negate the indication for chemoprophylaxis. In the meantime, caution is suggested in the use of this class of medications in patients presenting with undiagnosed severe pain where necrotizing fasciitis is a part of the differential diagnosis.
Early diagnosis requires awareness of the presenting features and a high index of suspicion.
Chemoprophylaxis should be given in cases of STSS and necrotizing fasciitis, and the recommendations of local public health departments in the area of residence of the practitioner involved should be sought. Clinical and bacteriologic observations of a toxic shock like syndrome due to Streptococcus pyogenes . Stevens DL, Tanner MH, Winship J, et al. Wheeler MC, Roe MH, Kaplan EL, et al. A streptococcus septicemia in children.