Toxic shock syndrome medical therapy: Difference between revisions
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{{Toxic shock syndrome}} | {{Toxic shock syndrome}} | ||
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==Overview== | ==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== | ==Medical Therapy== | ||
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[[Category:Syndromes]] | [[Category:Syndromes]] | ||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
[[Category:Infectious Disease Project]] | [[Category:Infectious Disease Project]] | ||
Revision as of 14:48, 27 August 2015
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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
- Control blood pressure
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]
- 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]
- 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
- ↑ 1.0 1.1 Lappin E, Ferguson AJ (2009). "Gram-positive toxic shock syndromes". Lancet Infect Dis. 9 (5): 281–90. doi:10.1016/S1473-3099(09)70066-0. PMID 19393958.