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Case report
Efficacy of colistimethate sodium as local application in necrotising fasciitis
  1. Sreedutt Murali,
  2. Anoop V Pillai and
  3. Riju Ramachandran
  1. General Surgery, Amrita Institute of Medical Sciences, Ernakulam, India
  1. Correspondence to Dr Riju Ramachandran; rijurmenon{at}


Necrotising fasciitis (NF) is a rapidly progressive severe soft tissue infection of the deep fascia resulting in the destruction of overlying subcutaneous tissue and skin. We report the case of NF of the lower limb with a poor prognosis due to multidrug-resistant (MDR) Klebsiella pneumoniae (K. pneumoniae) sensitive only to colistin. In view of the worsening condition of the wound, risk of deterioration of renal function and economic constraints, it was decided to start on colistin therapy locally by colistimethate sodium (CMS). The patient responded well to the treatment and got clinically better. Subsequent culture sent for post-treatment showed no growth of the organism. The wound healed with regular dressings by 8 weeks. This was found to be a very cost-effective treatment modality. Local use of CMS was found to be a novel method of achieving infection-free wound especially against MDR K. pneumoniae.

  • drug therapy related to surgery
  • infections
  • health economics
  • wound care
  • General surgery

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  • Contributors SM: concept, acquisition, interpretation of data, drafting the paper and final approval. AVP: acquisition of data, revising critically and final approval. RR: concept, design, interpretation of data, revising critically for important intellectual content and final approval. All the authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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