Emerging treatments

Hyperbaric oxygen (HBO) therapy

HBO therapy has been advocated by some physicians based upon its beneficial effects on cutaneous wound healing, but there is a lack of prospective controlled studies to demonstrate its efficacy.[1][74] HBO therapy is not recommended in England for necrotising fasciitis.[1][74][75] It may be readily available and recommended for this indication in other regions; HBO therapy must never delay surgical debridement or appropriate antibiotic treatment. 

Newer antibiotics

Antibiotics with activity against gram-positive organisms (including MRSA), such as the second-generation glycopeptide antibiotic oritavancin and the fluoroquinolone delafloxacin, may be considered for inclusion in an antimicrobial regimen for necrotising fasciitis, where available.[76][77][78]​ However, clinical data supporting their use are limited, the efficacy of these agents has not been rigorously demonstrated in necrotising fasciitis, and there are significant adverse effects associated with each of these agents. With the exception of use in uncommon and specific antibiotic resistance patterns in an isolated causative organism, there is thus far no compelling evidence to recommend their use in necrotising fasciitis. 

Reltecimod

Reltecimod is an immune-modulating peptide derived from the T-cell receptor CD28, which targets the co-stimulatory pathway that induces pro-inflammatory cytokines. It has been shown to be of benefit in bacterial infections including necrotising fasciitis.[4]​ In one study in necrotising fasciitis, reltecimod was associated with faster resolution of organ dysfunction and hospital discharge; however, further studies are needed.[4]​ It is not currently licensed or available in the UK.  

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