Toxic Shock Syndrome
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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).
|Etiology||Antibiotic Therapy||Adjunctive Therapy||Notes|
|Group A β-hemolytic Streptococcus (GABHS)||Penicillin G 4 million units IV q4h + clindamycin 900 mg IV q8h for 10–14 d||IVIG 1 g/kg on day 1, then 0.5 g/kg on days 2 and 3||Surgical debridement is almost always indicated for necrotizing infections. Clindamycin is added to decrease toxin production.|
|Staphylococcus aureus||Oxacillin 2 g IV q4h or vancomycin 1 g IV q12h + clindamycin 900 mg IV q8h for 10–14 d||IVIG as per GABHS may be useful in severe cases, but higher doses may be needed||Surgical 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.