Washington Manual of Medical Therapeutics
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.
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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.
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