TAILIEUCHUNG - Chapter 130. Streptococcal and Enterococcal Infections (Part 9)

Streptococcal Toxic Shock Syndrome: Treatment In light of the possible role of pyrogenic exotoxins or other streptococcal toxins in streptococcal TSS, treatment with clindamycin has been advocated by some authorities (Table 130-3), who argue that, through its direct action on protein synthesis, clindamycin is more effective in rapidly terminating toxin production than penicillin—a cell-wall agent. Support for this view comes from studies of an experimental model of streptococcal myositis, in which mice given clindamycin had a higher rate of survival than those given penicillin. Comparable data on the treatment of human infections are not available. Although clindamycin resistance in GAS. | Chapter 130. Streptococcal and Enterococcal Infections Part 9 Streptococcal Toxic Shock Syndrome Treatment In light of the possible role of pyrogenic exotoxins or other streptococcal toxins in streptococcal TSS treatment with clindamycin has been advocated by some authorities Table 130-3 who argue that through its direct action on protein synthesis clindamycin is more effective in rapidly terminating toxin production than penicillin a cell-wall agent. Support for this view comes from studies of an experimental model of streptococcal myositis in which mice given clindamycin had a higher rate of survival than those given penicillin. Comparable data on the treatment of human infections are not available. Although clindamycin resistance in GAS is uncommon 2 among . isolates it has been documented. Thus if clindamycin is used for initial treatment of a critically ill patient penicillin should be given as well until the antibiotic susceptibility of the streptococcal isolate is known. Intravenous immunoglobulin has been used as adjunctive therapy for streptococcal TSS Table 130-3 . Pooled immunoglobulin preparations contain antibodies capable of neutralizing the effects of streptococcal toxins. Anecdotal reports and case series have suggested favorable clinical responses to intravenous immunoglobulin but no prospective controlled trials have been reported. Prevention No vaccine against GAS is commercially available. A formulation that consists of recombinant peptides containing epitopes of 26 M-protein types has undergone phase I and II testing in volunteers. Early results indicate that the vaccine is well tolerated and elicits type-specific antibody responses. Household contacts of individuals with invasive GAS infection . bacteremia necrotizing fasciitis or streptococcal TSS are at greater risk of invasive infection than the general population. Asymptomatic pharyngeal colonization with GAS has been detected in up to 25 of persons with 4 h d of same-room exposure .

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