This handout is for toxic shock syndrome (staphylococcal & streptococcal). Your care team identified this based on: fever (≥ 38.9 °c) + diffuse macular "sunburn" erythroderma ± mucous-membrane hyperaemia — toxic shock syndrome until proven otherwise; obtain cultures + remove any tampon/packing + start empiric anti-toxin regimen (cdc staph tss case definition; stevens idsa ssti 2014 pmid 24973422).
Other reasons your team may use this plan: hypotension (sbp < 90 mmhg or orthostatic drop) with fever + diffuse erythroderma ± ≥ 3-organ involvement — tss shock; ssc hour-1 bundle + cross-route id.sepsis.core.v1 (cdc; ssc 2026); tampon / vaginal or nasal packing / foreign body in situ with fever ± rash ± hypotension — menstrual or packing-associated staphylococcal tss; remove the foreign body immediately (primary source control) (cdc; stevens idsa ssti 2014); rapidly progressive soft-tissue pain out of proportion ± hemorrhagic bullae / crepitus / anaesthesia + systemic toxicity — streptococcal tss with necrotising fasciitis / myositis; emergent surgical exploration + cross-route id.necrotising-fasciitis.core.v1 (stevens idsa ssti 2014; sartelli wses/sis 2021 pmid 34022909).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| remove_foreign_body_and_surgical_source_control | Immediate removal of tampon / vaginal or nasal packing / foreign body; explore + drain surgical-wound or abscess focus even if locally bland (toxin out of proportion); EMERGENT surgical debridement + mandatory 24-48 h second-look for streptococcal TSS with necrotising fasciitis/myositis (cross-route id.necrotising-fasciitis.core.v1) — do NOT delay surgery for imaging | procedural | immediate / emergent (within 1 h of recognition for nec fasc) | Source control is non-negotiable + time-critical — foreign-body removal is the primary source-control act in menstrual/packing staph TSS; emergent debridement is the dominant survival determinant in streptococcal TSS with necrotising soft-tissue infection (Stevens IDSA SSTI 2014 PMID 24973422; Sartelli WSES/SIS 2021 PMID 34022909; CDC) |
Plan: TSS source control (remove tampon/packing/foreign body; emergent debridement if strep + nec fasc) + anti-toxin antibiotics (anti-staph β-lactam/vancomycin OR penicillin G for GAS, ALWAYS + clindamycin toxin suppression) + adjunctive IVIG (strep / refractory) + hemodynamic resuscitation (SSC 2026 Hour-1 bundle)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Recovery + palmar/plantar desquamation course (1-3 wk — confirmatory, expected); recurrence counselling — menstrual staphylococcal TSS recurs (avoid high-absorbency tampons; consider S. aureus nasal/vaginal carriage decolonisation); GAS-contact chemoprophylaxis discussion for severe invasive streptococcal TSS per public-health guidance; organ-recovery follow-up (renal/hepatic/cardiac as involved); return precautions (recurrent fever, rash, hypotension); address residual source (wound/abscess/nec-fasc reconstruction via id.necrotising-fasciitis.core.v1) (CDC; Stevens IDSA SSTI 2014)
Guideline: IDSA SSTI Guideline (Stevens DL et al, Clinical Infectious Diseases 2014 — PMID 24973422; defines TSS empiric antibiotic + protein-synthesis-inhibitor [clindamycin] toxin suppression + IVIG Class IIa for streptococcal TSS + source-control logic) + CDC Toxic Shock Syndrome case definitions (staphylococcal: fever ≥ 38.9 °C + diffuse macular erythroderma + hypotension + ≥ 3-organ involvement + desquamation [late] + negative alternative serologies; streptococcal: group A streptococcus isolation [sterile site = confirmed, non-sterile = probable] + hypotension + ≥ 2 organ-system involvement) + Surviving Sepsis Campaign 2026 (distributive/toxic-shock resuscitation backbone — Hour-1 bundle, vasoactive titration, organ support) + Darenberg CID 2003 IVIG-in-STSS RCT (PMID 12884159 — underpowered, trend benefit) + Linnér CID 2014 IVIG-in-STSS observational cohort (PMID 24928291 — adjusted mortality OR ≈ 0.30) + Stevens JID 1988 clindamycin Eagle effect (PMID 2839555) + Sartelli WSES/SIS NF 2021 (PMID 34022909 — emergent debridement when STSS co-presents with necrotising soft-tissue infection) + Wong LRINEC CCM 2004 (PMID 15241098) + Rybak ASHP/IDSA vancomycin AUC 2020 (PMID 32191793) + Kumar CCM 2006 (PMID 16625125 — antibiotic-delay mortality)