Monday, April 05, 2010

The experience of a sage clinician and pathophysiologic rationale trump EBM, save life and limb

At least this story is pretty convincing that it did for a patient with Group A streptococcal TSS and necrotizing fasciitis.

The treatment under consideration: corticosteroids as an adjunct to debridement and antibiotics.

The clinical experience: several cases decades earlier exhibiting dramatic improvement with steroids.

The pathophysiologic rationale: Group A streptococci are exquisitely sensitive to antibiotics and an exuberant immune response is not needed. This same immune response is injurious to tissues and needs to be moderated.

Caveat: This may not apply to other forms of necrotizing fasciitis, such as those due to MRSA and mixed infections.

More on this general topic later as time permits.

Via Vanderbilt House Organ.

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