Staphylococcal toxic shock syndrome
Staphylococcal toxic shock syndrome is a rare toxin-mediated disease that can develop after an apparently minor infection, or in patients colonised with a toxin-producing Staphylococcus aureus strain. Approximately 50% of cases are associated with tampon use. Clinical symptoms resemble streptococcal toxic shock syndrome. Gastrointestinal symptoms, in particular profuse diarrhoea, are also common.
For patients with staphylococcal toxic shock syndrome, immediately start appropriate resuscitation and organ support, and empirical therapy with vancomycin plus either cefazolin or flucloxacillin (as for Empirical therapy for Staphylococcus aureus bacteraemia).
Despite a lack of clinical evidence, consider adjunctive clindamycin as a strategy to reduce bacterial toxin production. Add to vancomycin plus cefazolin or flucloxacillin:
clindamycin 600 mg (child: 15 mg/kg up to 600 mg) intravenously, 8-hourly for the first 72 hours1. clindamycin clindamycin clindamycin
Consider intravenous immunoglobulin (IVIg), particularly in patients who do not respond to fluid resuscitation. If available, add to the above regimens:
intravenous immunoglobulin (IVIg) (adult and child) 2 g/kg intravenously, as a single dose as soon as possible but not later than 72 hours. It is reasonable to give the dose in divided doses if it is not possible to give a single dose. intravenous immunoglobulin (IVIg) intravenous immunoglobulin (IVIg) intravenous immunoglobulin (IVIg)
Modify therapy based on the results of susceptibility testing. Data to inform the duration of antibiotic therapy are limited – seek expert advice.
Treatment of the source of infection is an important component of therapy.