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Staphylococcal TSS Clindamycin — SCE Infectious Diseases MCQ

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ModerateHealthcare-Associated InfectionsStaphylococcal TSS ClindamycinSCE Infectious Diseases

A 32-year-old woman develops toxic shock syndrome with fever, hypotension, diffuse erythematous rash, and desquamation. She has a retained vaginal foreign body (tampon) removed. Blood cultures are negative but the tampon culture grows Staphylococcus aureus (TSST-1 producing). What is the key antibiotic adjunct to suppress toxin production?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: B — IV Clindamycin 1.2 g QDS

Explanation lettering: C = shown as A · D = shown as B · A = shown as C · E = shown as D · B = shown as E

Staphylococcal TSS is mediated by the superantigen TSST-1 (or enterotoxin B/C). The key adjunctive antibiotic is Clindamycin (or Linezolid), which inhibits bacterial protein synthesis at the ribosomal level, directly suppressing toxin production. This is in addition to anti-staphylococcal antibiotics (IV Flucloxacillin for MSSA). Beta-lactams alone kill bacteria (bactericidal) but do not directly suppress ongoing toxin production during bacterial lysis. IVIG (2 g/kg) may also be considered for severe TSS to neutralise circulating superantigen.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/infections