How should I manage a patient with suspected necrotizing fasciitis before referring them to secondary care?

Immediate management of a patient with suspected necrotizing fasciitis before referral to secondary care includes:

• Urgent recognition and assessment: Identify signs of severe soft tissue infection with systemic toxicity, such as severe pain disproportionate to clinical findings, rapid progression, and systemic signs of sepsis.
• Do not delay referral: Necrotizing fasciitis is a surgical emergency requiring urgent secondary care assessment and intervention.
• Initiate early intravenous broad-spectrum antibiotics: Start empirical intravenous antibiotics that cover likely causative organisms, including anaerobes and resistant bacteria such as MRSA if suspected. Antibiotic choice should be guided by local protocols and microbiological advice.
• Supportive care: Ensure resuscitation facilities are available, monitor vital signs, and manage sepsis according to local protocols while awaiting transfer.
• Pre-alert secondary care: Inform the receiving hospital urgently to prepare for immediate surgical intervention and critical care support.

These steps are critical to reduce morbidity and mortality associated with necrotizing fasciitis and align with NICE guidance on managing severe infections and suspected sepsis in community settings ³. Early antibiotic therapy and rapid transfer to secondary care for surgical debridement are essential ³.