Antibiotics for treatment of Toxic shock syndrome (TSS):

Ans: (b) ClindamycinRef: Harrison, 19th edition, Page 780Antibiotics for treatment of Toxic shock syndrome (TSS)TSS is usually managed in the intensive care setting and the main line of management is supportive management along with appropriate antibiotic therapy to eradicate Staph, aureus which is mostly the causative organism.Because of the increasing frequency of methicillin-resistant Staphylococci in the community, vancomycin is often recommended*.Beta lactamase resistant penicillins are not very effective due to emerging resistance and they may increase TSST-1 production in vitro probably due to cell lysis. Hence, if they are prescribed they are usually coprescribed with clindamycin which inhibits bacterial protein toxin production.Other treatment options are a combination of vancomycin and clindamycin for suspected serious staphylococcal infections pending culture and sensitivity.Intravenous immunoglobulin (IVIG; which presumably acts in part via neutralizing antibodies against toxins) has been used and appears to have significant promise. At present, IVIG is used in severe or recalcitrant cases.Treatment of choice:Vancomycin (15 mg/kg q12h) plus Clindamycin (600 mg q8h).If a penicillin or oxacillin-sensitive strain is isolated, o Penicillin or Oxacillin can be given.In severe cases:IV immunoglobulins.