Management of Gas Gangrene

In this article, we will discuss the Management of Gas Gangrene. So, let’s get started.

Management

1. Eradication of source of infection

(a) Surgery: It includes debridement of local soft tissue infection, treatment of all the involved muscles in the abdominal myonecrosis or surgical removal of the source of infection such as amputation of a limb or hysterectomy for uterine myonecrosis.

(b) Antibiotics: Penicillin g (20 million units a day) in adults have been the drug of choice till now. Recently its role has become controversial because of increasing resistance to this drug. Clindamycin (600 mg every 6 hourly) and penicillin combination has been found to be superior than either of them alone. In case of penicillin allergy, other antibiotic (chloramphenicol, metronidazole, imipenem, doxycycline) should be used. Broad spectrum antibiotic with aminoglycoside may be used for the aerobic (supportive) gram-negative bacteria involved in the mixed infections.

2. Polyvalent gas gangrene antitoxin: It is still recommended by some authorities but at present its role has become controversial because of questionable efficacy and risk of hypersensitivity to horse serum from which it is derived.

3. Hyperbaric oxygen: Its role has also become questionable because:

(a) Its efficacy is not proved but addition of hyperbaric oxygen to the therapeutic regimen provides additional benefit provided if surgery and antibiotic therapy proceed oxygen therapy.

(b) Expert surgical and medical management and control of complication are the most important factors in the treatment of gas gangrene.