What drug is often used for empiric antibiotic therapy in necrotizing fasciitis?

Clindamycin is often chosen for empiric antibiotic therapy in necrotizing fasciitis for several important reasons. This severe and rapidly progressing infection, often caused by polymicrobial flora including Gram-positive cocci, Gram-negative rods, and anaerobes, requires a broad-spectrum antibiotic strategy. Clindamycin is particularly effective because it not only has excellent coverage against streptococci and staphylococci but also possesses significant activity against anaerobic bacteria, which are frequently involved in these infections.

One of the critical features of clindamycin is its ability to inhibit toxin production from certain strains of Staphylococcus aureus, including those that produce toxic shock syndrome toxin (TSST). This property can be crucial in managing severe soft tissue infections where toxins can contribute to the rapid progression of the disease and systemic effects.

In contrast, amoxicillin may not be suitable because it primarily targets susceptible Gram-positive bacteria and does not provide adequate coverage against the anaerobes typically found in necrotizing fasciitis. Nafcillin, while effective against methicillin-sensitive Staphylococcus aureus, lacks anaerobic coverage. Ceftriaxone provides broader Gram-negative coverage and can be part of regimens for other infections but does not address the