Toxic Shock Syndrome

Toxic Shock Syndrome is a topic covered in the Washington Manual of Medical Therapeutics.

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Toxic shock syndrome (TSS) is a life-threatening systemic disease caused by exotoxin superantigens produced by Staphylococcus aureus or group A β-hemolytic Streptococcus (GABHS) (Table 14-1).

Table 14-1: Treatment of Toxic Shock Syndromes
EtiologyAntibiotic TherapyAdjunctive TherapyNotes
Group A β-hemolytic Streptococcus (GABHS)Penicillin G 4 million units IV q4h + clindamycin 900 mg IV q8h for 10–14 dIVIG 1 g/kg on day 1, then 0.5 g/kg on days 2 and 3Surgical debridement is almost always indicated for necrotizing infections. Clindamycin is added to decrease toxin production.
Staphylococcus aureusOxacillin 2 g IV q4h or vancomycin 1 g IV q12h + clindamycin 900 mg IV q8h for 10–14 dIVIG as per GABHS may be useful in severe cases, but higher doses may be neededSurgical debridement may be necessary for wounds. Tampons and other foreign bodies should be removed and avoided in future, especially if TSST-1 antibody titers are negative.

IVIG, intravenous immunoglobulin; TSST-1, toxic shock syndrome toxin 1.

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Toxic shock syndrome (TSS) is a life-threatening systemic disease caused by exotoxin superantigens produced by Staphylococcus aureus or group A β-hemolytic Streptococcus (GABHS) (Table 14-1).

Table 14-1: Treatment of Toxic Shock Syndromes
EtiologyAntibiotic TherapyAdjunctive TherapyNotes
Group A β-hemolytic Streptococcus (GABHS)Penicillin G 4 million units IV q4h + clindamycin 900 mg IV q8h for 10–14 dIVIG 1 g/kg on day 1, then 0.5 g/kg on days 2 and 3Surgical debridement is almost always indicated for necrotizing infections. Clindamycin is added to decrease toxin production.
Staphylococcus aureusOxacillin 2 g IV q4h or vancomycin 1 g IV q12h + clindamycin 900 mg IV q8h for 10–14 dIVIG as per GABHS may be useful in severe cases, but higher doses may be neededSurgical debridement may be necessary for wounds. Tampons and other foreign bodies should be removed and avoided in future, especially if TSST-1 antibody titers are negative.

IVIG, intravenous immunoglobulin; TSST-1, toxic shock syndrome toxin 1.

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