Editing Necrotising fasciitis (section)

== '''Resuscitation''' ==

** Blood cultures first
** Bacterial haemolysis often occurs, meaning haematocrit drops before Hb. Base transfusion on haematocrit rather than Hb.
** Need to give a lot of IVF, and albumin along with it
** Antibiotics: 
*** First-line: meropenem 1g TDS/tazocin 4.5g TDS + vancomycin 25-30mg/kg loading dose + clindamycin 600mg TDS/lincomycin 600mg TDS
*** Add ciprofloxacin 400mg TDS if there is a risk of water-borne infection
*** Severe penicillin allergy: generally still give meropenem, but 1% risk of cross-reactivity, seek ID advice. They may advise a regime of gentamicin or ciprofloxacin and metronidazole instead. 
** IVIg has been shown to reduce 30-day mortality from 33% to 15% in a 2018 meta-analysis, but only in the setting of setreptococcal infection
** Droplet and contact precautions for first 24 hours, if suspicious for GAS