Box 1.

Empiric Antibiotic Regimen for Fournier’s Gangrene

Carbapenem (Imipenem, meropenem, or ertapenem) OR Beta lactam-beta lactamase inhibitor (piperacillin-tazobactam or ampicillin-sulbactam) PLUS Clindamycin for its activity against gram-positive organisms and anaerobes, as well as its antitoxin effects PLUS Vancomycin, daptomycin, or linezolid for activity against gram-positive organisms and MRSA

In patients with severe hypersensitivity to carbapenems or beta lactam-beta lactamase inhibitors, consider: Aminoglycoside OR Fluoroquinolone PLUS Metronidazole

In patients with salt or freshwater exposure, consider adding: Doxycycline

In patients with significant risk for fungal involvement, consider adding: Amphotericin B or fluoroconazoles

Note: Reprinted from J Emerg Med. 57(4): Montrief T, Long B, Koyfman A, Auerbach J. Fournier gangrene: a review for emergency clinicians. 488–500, Copyright (2019), with permission from Elsevier.⁵⁹

Abbreviation: MRSA, methicillin-resistant Staphylococcus aureus.