The initial treatment of STSS is similar to that of TSS, with aggressive management of shock and early use of vasopressors (see " Treatment" under "TgxicShock^ Syndrome"). Antibiotic therapy should be initiated immediately in the emergency department to treat STSS and the associated infection, if present; intravenous penicillin G, 24 million U/day in divided doses, and intravenous clindamycin, 900 mg every 8 h. 12 Erythromycin should be used in penicillin-allergic patients. Intravenous immunoglobulin may be useful in the treatment of invasive GAS infections associated with STSS. 18 Although antibiotics are important, prompt and aggressive exploration and d├ębridement of suspected deep-seated S. pyogenes infection are mandatory. If STSS is suspected, immediate surgical consultation is indicated, since 70 percent of patients with STSS require d├ębridement, fasciotomy, or amputation.

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