Toxic shock syndrome medical therapy

Toxic shock syndrome Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Toxic Shock Syndrome from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
History and Symptoms
Physical Examination
Laboratory Findings
X Ray
CT
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Toxic shock syndrome medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Toxic shock syndrome medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Toxic shock syndrome medical therapy
CDC on Toxic shock syndrome medical therapy
Toxic shock syndrome medical therapy in the news
Blogs on Toxic shock syndrome medical therapy
Directions to Hospitals Treating Toxic shock syndrome
Risk calculators and risk factors for Toxic shock syndrome medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The initial management of toxic shock syndrome involves the removal of any foreign materials such as tampons, vaginal sponges, or nasal packing. Antimicrobial therapy is indicated in toxic shock syndrome. Supportive therapy for toxic shock syndrome includes intravenous fluids, control of blood pressure, and dialysis in cases of renal failure. Patients with multiple organ failure are admitted to the intensive care unit.

Medical Therapy

Any foreign materials, such as tampons, vaginal sponges, or nasal packing, will be removed. Sites of infection (such as a surgical wound) will be drained. The goal of treatment is to maintain important body functions. This may include:

• Antibiotics
• Dialysis (in renal failure)
• IV fluids:
  • To control hypotension

Sometimes it is required that patients are admitted to the intensive care unit for supportive care in case of multiple organ failure.

• Staphylococcal toxic shock syndrome

• 1. Methicillin sensitive Staphylococcus aureus

• Preferred regimen (1): Cloxacillin 250-500 mg PO qid (maximum dose: 4 g/24 hr)
• Preferred regimen (2): Nafcillin 4-12 g/24 hr IV q4-6hr (maximum dose: 12 g/24 hr)
• Preferred regimen (3): Cefazolin 0.5-2g IV/IM q8h (maximum dose: 12 g/24 hr), AND Clindamycin 150-600 mg IV/IM/PO q6-8h (maximum dose: 5 g/24 hr IV/IM or 2 g/24 hr PO)
• Alternative regimen (1): Clarithromycin 250-500 mg PO q12h (maximum dose: 1 g/24 hr) AND Clindamycin 150-600 mg IV/IM/PO q6-8h (maximum dose: 5 g/24 hr IV/IM or 2 g/24 hr PO)
• Alternative regimen (1): Rifampicin, AND Linezolid 600 mg IV/PO q12hr
• Alternative regimen (2): Daptomycin
• Alternative regimen (3): Tigecycline 100 mg IV loading dose followed by 50 mg q12h

• 2. Methicillin resistant Staphylococcus aureus

• Preferred regimen: Clindamycin 150-600 mg q6-8h IV/IM/PO (max dose: 5 g/24 hr IV or IM or 2 g/24 hr PO)
• Preferred regimen: Linezolid 600 mg IV/PO q12h AND (Vancomycin 15 to 20 mg/kg IV q8-12h, not to exceed 2 g per dose or Teicoplanin)
• Alternative regimen (1): Rifampicin AND Linezolid 600 mg IV/PO q12h
• Alternative regimen (2): Daptomycin
• Alternative regimen (3): Tigecycline 100 mg loading dose followed by 50 mg IV q12h

• 3. Glycopeptide resistant or intermediate Staphylococcus aureus

• Preferred regimen: Linezolid 600 mg IV/PO q12h AND Clindamycin 150-600 mg IM/IV/PO q6-8h (maximum dose: 5 g/24 hr IV/IM or 2 g/24 hr PO) (if sensitive)
• Alternative regimen: Daptomycin OR Tigecycline 100 mg loading dose followed by 50 mg IV q12h

• Streptococcal toxic shock syndrome

• 1. Group A streptococcus

• Preferred regimen: Penicillin G, 2–4 MU IV q4–6h AND Clindamycin 600–900 mg q8h IV, (maximum dose: 5 g/24 hr IV/IM or 2 g/24 hr PO)
• Alternative regimen (1): (Macrolide Azithromycin 500 mg PO day 1 followed by 250 mg for 4 days
• Alternative regimen (2): Fluoroquinolone Oxacillin 2-12 g/24 hr divided q4-6h IV (maximum dose: 12 g/24 hr)), AND Clindamycin 150-600 mg q6-8h IV, IM, or PO (max dose: 5 g/24 hr IV/IM or 2 g/24 hr PO)
• Alternative regimen (3): Linezolid 600 mg IV/PO q12h
• Alternative regimen (4): Daptomycin OR Tigecycline 100 mg loading dose followed by 50 mg q12h IV
• Note: Macrolide and Fluoroquinolone resistance increasing

• 2. Macrolide, lincosamide, and streptogramin B (MLS) resistant group A streptococcus

• Preferred regimen: Penicillin G 2-24 MU/24h IV/IM q4-6h AND (Vancomycin 15 to 20 mg/kg IV q8-12h, not to exceed 2 g/dose OR Teicoplanin)
• Alternative regimen (1): Vancomycin 15 to 20 mg/kg IV q8-12h, not to exceed 2 g/dose OR Teicoplanin
• Alternative regimen (2): Linezolid 600 mg IV/PO q12h
• Alternative regimen (3): Daptomycin
• Alternative regimen (4): Tigecycline 100 mg IV loading dose followed by 50 mg q12h
• Alternative regimen (5): Teicoplanin
• Note: Macrolide resistance associated with Clindamycin resistance

References

Template:WikiDoc Sources