13.4 Toxic shock syndrome
| Type of Infection | First Line (with Dosage and Duration) |
Alternative First Line (with dosage and Duration) |
Comments |
|---|---|---|---|
| Toxic shock syndrome (TSS) is a rare, life- threatening condition with high grade fever, hypotension, rash, organ failure | Penicillin Crystalline (24 million unit /day) + Clindamycin 900mg 8h Duration: 7- 10 days | Cefazolin (1-2mg 8h) + Clindamycin 600- 900 mg IV q8h Or Vancomycin 15mg/kg IV q8h Duration: 7-10 days | TSS can be cause by Staphylococcus aureus, streptococcus (Group A) or rarely by Clostridium Sordellii. It may not be possible to pinpoint the etiological agents based on clinical syndromes, but presence of a deep-seated foci (like blunt trauma) or clear signs of skin soft tissue infection are more in favour of TSS caused by Group A Streptococcus. Presence of a minor superficial skin infection or history of use of vaginal tampons can give clue to TSS caused by Staphylococcus aureus. Blood cultures, culture and gram stain from an infected site are needed to attain microbiological diagnosis |
For common etiological agents of Toxic shock syndrome, see Annexure B.13.4
Additional Information
- TSS is a toxin-mediated disease that is caused by toxin-producing streptococci or S. aureus. Staphylococcal TSS is likely to cause vomiting, diarrhoea, myalgia, elevated creatine kinase, mucositis, hepatic damage, thrombocytopenia, and confusion. The staphylococcal TSS rash is more likely to desquamate, particularly on the palms and soles, between 3 and 7 days after onset.
References
1. Stanford Guidelines on Antimicrobial Therapy 2024.
2. Allen JM, Surajbali D, Q Nguyen D, Kuczek J, Tran M, Hachey B, Feild C, Shoulders BR, Smith SM, Voils SA. Impact of Piperacillin-Tazobactam Dosing in Septic Shock Patients Using Real- World Evidence: An Observational, Retrospective Cohort Study. Ann Pharmacother. 2023 Jun;57(6):653-661. doi: 10.1177/10600280221125919. Epub 2022 Sep 25. PMID: 36154486; PMCID: PMC10433263.
3. Atchade E, De Tymowski C, Grall N, Tanaka S, Montravers P. Toxic Shock Syndrome: A Literature Review. Antibiotics (Basel). 2024 Jan 18;13(1):96. doi: 10.3390/antibiotics13010096. PMID: 38247655; PMCID: PMC10812596