Treatment of Clostridial Infections
| Condition | Antibiotic Treatment | Penicillin Allergy | Adjunctive Treatment/Note |
|---|---|---|---|
| Wound contamination | None | — | Treatment should be based on clinical signs and symptoms as listed below and not solely on bacteriologic findings. |
| Polymicrobial anaerobic infections involving clostridia (e.g., abdominal wall, gynecologic) | Ampicillin (2 g IV q4h) plus Clindamycin (600-900 mg IV q6-8h) plus Ciprofloxacin (400 mg IV q6-8 h) | Vancomycin (1 g IV q12h) plus Metronidazole (500 mg IV q6h) plus Ciprofloxacin (400 mg IV q6-8h) | Empirical therapy should be initiated. Therapy should be based on Gram's stain and culture results and on sensitivity data when available. Add gram-negative coverage if indicated (see text). |
| Clostridial sepsis | Penicillin, 3-4 mU IV q4-6h plus Clindamycin (600-900 mg IV q6-8h) | Clindamycin alone or Metronidazole (as above) or Vancomycin (as above) | Transient bacteremia without signs of systemic toxicity may be clinically insignificant. |
| Gas gangrene | Penicillin G (4 mU IV q4-6h) plus Clindamycin (600-900 mg IV q6-8h) | Cefoxitin (2 g IV q6h) plus Clindamycin (600-900 mg IV q6-8h) | Emergent surgical exploration and thorough debridement are extremely important. Hyperbaric oxygen therapy may be considered after surgery and antibiotic initiation. |