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 débridement 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 débridement, fasciotomy, or amputation.
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