Treatment Of S Aureus Disease Toxin Mediated Disease

Management of TSS often includes the need for a high-dependency setting. The presence of tampons should be determined and removed where appropriate, and possible sources of infection should be carefully considered in non-menstrual cases. Cultures should be taken for the isolation of S. aureus and the organism sent to a reference laboratory to determine TSST-1 production if the diagnosis is in doubt. Acute and convalescent sera should be taken and stored and tested for evidence of seroconversion to TSST-1 in doubtful cases. The need for other investigations should be guided by clinical need. A P-lactamase-resistant anti-staphylococcal antibiotic should be given to eradicate the toxin-producing strain of S. aureus. Clindamycin has been advocated for use as an adjunct to penicillin for the treatment of streptococcal TSS because of its ability to reduce toxin production in vitro (Sriskandan etal. 1997; Mascini etal. 2001). Evidence for the value of clindamycin in TSS caused by S. aureus is laboratory based. The effect of clindamycin, flucloxacillin or flucloxacillin plus gentamicin has been defined in terms of S. aureus growth and toxin production in vitro. Flucloxacillin alone or in combination with gentamicin was rapidly cidal, but clindamycin was bacteriostatic for logarithmic phase cultures. All three inhibited toxin production during logarithmic growth, with inhibition of 75%, 30% and 75% of the control, respectively, during stationary phase growth (van Langevelde etal. 1997). The relevance of these data to clinical practice is unclear, but many centres commonly give combination therapy using a P-lactamase-resistant anti-staphylococcal antibiotic plus clindamycin. The case fatality rate is reported to be 3%, although this reflects the outcome of individuals treated in affluent nations.

Fluid and electrolyte replacement are the mainstay of the treatment for scalded skin syndrome. Antibiotics are given to eradicate the toxin-producing S. aureus isolate. Fever usually settles after 2 or 3 days, and no new bullae form, although it takes 2-3 weeks for the skin lesions to resolve completely. Affected neonates should be isolated and strict barrier precautions applied to prevent cross-infection. Management of food poisoning requires fluid and electrolyte replacement, but antibiotic treatment is not necessary. The disease is self-limiting and usually resolves within 24 h.

0 0

Post a comment