December 1988

Toxic Shock Syndrome-Reply

Arch Otolaryngol Head Neck Surg. 1988;114(12):1478. doi:10.1001/archotol.1988.01860240128040

In Reply.—We thank Dr Kennedy for his comments regarding our article and understand and share his concern regarding the lack of prospective, randomized trials confirming or refuting the efficacy of antimicrobial prophylaxis for staphylococcal toxic shock syndrome. Our study remains the only one on this important topic, and in it we discussed the difficulty, if not impossibility, of studying this problem directly, and are careful to point out the limits of the study, which was confined to studying the effects of single-dose prophylaxis on nasal carriage of Staphylococcus aureus. We said, "It is difficult to endorse this particular approach to the prevention of postoperative [toxic shock syndrome] in patients who have undergone nasal surgery. Alternative approaches include early diagnosis, bacteriologic screening of patients, and different prophylactic regimens." With respect to this last point, we concur with Dr Kennedy that postoperative administration of antimicrobial prophylaxis has not yet been evaluated. We are,

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