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Corticosteroid Therapy for Patients With Toxic Shock Syndrome FREE

James K. Todd, MD; Marilyn Ressman, RN; Sharon A. Caston, RN; Barbara H. Todd, MSN; Andrew M. Wiesenthal, MD
[+] Author Affiliations

Read in part at the 22nd Interscience Conference on Antimicrobial Agents and Chemotherapy, Miami, Oct 5, 1982.

Reprint requests to The Children's Hospital of Denver, 1056 E 19th Ave, Denver, CO 80218 (Dr Todd).


JAMA. 1984;252(24):3399-3402. doi:10.1001/jama.1984.03350240045037
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A comparative retrospective analysis of 45 patients with toxic shock syndrome (TSS) was designed to evaluate the effect of corticosteroid therapy on outcome. All patients satisfied the collaborative strict case definition for TSS, were hospitalized, had shock or postural hypotension, had a potential focus of Staphylococcus aureus infection, and received appropriate antistaphylococcal antimicrobial therapy. Twenty-five patients received corticosteroid therapy during the acute phase of illness and 20 did not. The groups were comparable for age, sex, weight, year of admission, day of illness hospitalized, minimum systolic and diastolic blood pressure, severity of illness, co-intervention with antimicrobials and antipyretics, and amount of intravenous fluid received. Corticosteroid-treated patients had a significantly reduced severity of illness and duration of fever if treated within two to three days of onset of TSS.

(JAMA 1984;252:3399-3402)

REFERENCES

Todd J, Fishaut M, Kapral F, et al:  Toxic shock syndrome associated with phage group I staphylococci . Lancet 1978;;2:1116-1118.
Schumer W:  Steroids in the treatment of clinical septic shock . Ann Surg 1976;;184:333-341.
Quinn S, Snader TC:  Corticosteroid therapy for septic shock: Review and analysis . Drug Intell Clin Pharm 1980;;14:247-251.
Wiesenthal AM, Ressman M, Caston SA, et al:  Incidence of hospitalized toxic shock syndrome in defined populations, 1970-1980 . Presented at the 22nd Interscience Conference on Antimicrobial Agents and Chemotherapy, Miami, Oct 5, 1982 .
Shands KN, Schmid GP, Dan BB, et al:  Toxic shock syndrome in menstruating women . N Engl J Med 1980;;303:1436-1442.
Hollander M, Wolfe DA: Non-parametric Statistical Methods . New York, John Wiley & Sons Inc, 1973;, pp 68-75.
Swinscow TDV: Statistics at Square One . Bath, England, Dawson & Goodall Ltd, The Mendip Press, 1976;, p 54.
Klastersky J, Cappel R, Debusscher L:  Effectiveness of betamethasone in management of severe infections . N Engl J Med 1971;;284:1248-1250.
Todd JK:  Toxic shock syndrome—scientific uncertainty and the public media . Pediatrics 1981;;67:921-923.
Chesney PJ, Crass BA, Polyak MB, et al:  Toxic shock syndrome: Management and long-term sequelae . Ann Intern Med 1982;;96(pt (2) ):847-851.
Horwitz RI, Feinstein AR:  Methodologic standards and contradictory results in case-control research . Am J Med 1979;;66:556-564.
Weitzman S, Berger S:  Clinical trial design in studies of corticosteroids for bacterial infections . Ann Intern Med 1974;;81:36-42.
Goldfarb RD, Glenn TM:  Regulation of lysosomal membrane stabilization via cyclic nucleotides and prostaglandins: The effects of steroids and indomethacin , in Lefer AM, Schumer W (eds): Molecular and Cellular Aspects of Shock and Trauma . New York, Alan R Liss Inc, 1983;, pp 147-166.
Hammerschmidt DE, White JG, Craddock PR, et al:  Corticosteroids inhibit complement-induced granulocyte aggregation: A possible mechanism for their efficacy in shock states . J Clin Invest 1979;;63:798.
Kapral FA:  Epidermal toxin production by Staphylococcus aureus strains from patients with toxic shock syndrome . Ann Intern Med 1982;;96(pt (2) ):972-974.
Schlievert PM, Shands KN, Dan BB, et al:  Identification and characterization of an exotoxin from Staphylococcus aureus associated with toxic shock syndrome . J Infect Dis 1981;;143:509-516.
Bergdoll MS, Crass BA, Reiser RF, et al:  A new staphylococcal enterotoxin, enterotoxin F, associated with toxic shock syndrome Staphylococcus aureus isolates . Lancet 1981;;1:1017-1021.
Cohen ML, Falkow S:  Protein antigens from Staphylococcus aureus strains associated with toxic shock syndrome . Science 1981;;211:842-844.
Barbour AG:  Vaginal isolates of Staphylococcus aureus associated with toxic shock syndrome . Infect Immun 1981;;33:442-449.
Todd JK, Franco-Buff A, Lawellin DW, et al:  Phenotypic distinctiveness of Staphylococcus aureus strains associated with toxic shock syndrome . Infect Immun 1984;;45:339-344.
Todd JK:  Pathogenesis of toxic shock syndrome: Clinical-bacteriological correlates . Surv Synth Path Res 1984;;3:63-72.
Peterson PK, Schlievert PM, Conroy W, et al:  Protection against staphylococcal pyrogenic exotoxin type C-enhanced endotoxin lethality with methylprednisolone and IgG . J Infect Dis 1983;;147:358-359.
Lawellin DW, Franco-Buff A, Vasil ML, et al:  Effect of hydrocortisone on proteolytic and hemolytic activities of staphylococcal isolates from toxic shock syndrome . Presented at the Annual Meeting of the American Society for Microbiology, New Orleans, March 10, 1983 .
Davis JP, Osterholm MT, Helms CM, et al:  Tri-state toxic shock syndrome study, II. Clinical and laboratory findings . J Infect Dis 1982;; 145:441-448.

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Todd J, Fishaut M, Kapral F, et al:  Toxic shock syndrome associated with phage group I staphylococci . Lancet 1978;;2:1116-1118.
Schumer W:  Steroids in the treatment of clinical septic shock . Ann Surg 1976;;184:333-341.
Quinn S, Snader TC:  Corticosteroid therapy for septic shock: Review and analysis . Drug Intell Clin Pharm 1980;;14:247-251.
Wiesenthal AM, Ressman M, Caston SA, et al:  Incidence of hospitalized toxic shock syndrome in defined populations, 1970-1980 . Presented at the 22nd Interscience Conference on Antimicrobial Agents and Chemotherapy, Miami, Oct 5, 1982 .
Shands KN, Schmid GP, Dan BB, et al:  Toxic shock syndrome in menstruating women . N Engl J Med 1980;;303:1436-1442.
Hollander M, Wolfe DA: Non-parametric Statistical Methods . New York, John Wiley & Sons Inc, 1973;, pp 68-75.
Swinscow TDV: Statistics at Square One . Bath, England, Dawson & Goodall Ltd, The Mendip Press, 1976;, p 54.
Klastersky J, Cappel R, Debusscher L:  Effectiveness of betamethasone in management of severe infections . N Engl J Med 1971;;284:1248-1250.
Todd JK:  Toxic shock syndrome—scientific uncertainty and the public media . Pediatrics 1981;;67:921-923.
Chesney PJ, Crass BA, Polyak MB, et al:  Toxic shock syndrome: Management and long-term sequelae . Ann Intern Med 1982;;96(pt (2) ):847-851.
Horwitz RI, Feinstein AR:  Methodologic standards and contradictory results in case-control research . Am J Med 1979;;66:556-564.
Weitzman S, Berger S:  Clinical trial design in studies of corticosteroids for bacterial infections . Ann Intern Med 1974;;81:36-42.
Goldfarb RD, Glenn TM:  Regulation of lysosomal membrane stabilization via cyclic nucleotides and prostaglandins: The effects of steroids and indomethacin , in Lefer AM, Schumer W (eds): Molecular and Cellular Aspects of Shock and Trauma . New York, Alan R Liss Inc, 1983;, pp 147-166.
Hammerschmidt DE, White JG, Craddock PR, et al:  Corticosteroids inhibit complement-induced granulocyte aggregation: A possible mechanism for their efficacy in shock states . J Clin Invest 1979;;63:798.
Kapral FA:  Epidermal toxin production by Staphylococcus aureus strains from patients with toxic shock syndrome . Ann Intern Med 1982;;96(pt (2) ):972-974.
Schlievert PM, Shands KN, Dan BB, et al:  Identification and characterization of an exotoxin from Staphylococcus aureus associated with toxic shock syndrome . J Infect Dis 1981;;143:509-516.
Bergdoll MS, Crass BA, Reiser RF, et al:  A new staphylococcal enterotoxin, enterotoxin F, associated with toxic shock syndrome Staphylococcus aureus isolates . Lancet 1981;;1:1017-1021.
Cohen ML, Falkow S:  Protein antigens from Staphylococcus aureus strains associated with toxic shock syndrome . Science 1981;;211:842-844.
Barbour AG:  Vaginal isolates of Staphylococcus aureus associated with toxic shock syndrome . Infect Immun 1981;;33:442-449.
Todd JK, Franco-Buff A, Lawellin DW, et al:  Phenotypic distinctiveness of Staphylococcus aureus strains associated with toxic shock syndrome . Infect Immun 1984;;45:339-344.
Todd JK:  Pathogenesis of toxic shock syndrome: Clinical-bacteriological correlates . Surv Synth Path Res 1984;;3:63-72.
Peterson PK, Schlievert PM, Conroy W, et al:  Protection against staphylococcal pyrogenic exotoxin type C-enhanced endotoxin lethality with methylprednisolone and IgG . J Infect Dis 1983;;147:358-359.
Lawellin DW, Franco-Buff A, Vasil ML, et al:  Effect of hydrocortisone on proteolytic and hemolytic activities of staphylococcal isolates from toxic shock syndrome . Presented at the Annual Meeting of the American Society for Microbiology, New Orleans, March 10, 1983 .
Davis JP, Osterholm MT, Helms CM, et al:  Tri-state toxic shock syndrome study, II. Clinical and laboratory findings . J Infect Dis 1982;; 145:441-448.
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