CBRNE - Staphylococcal Enterotoxin B Treatment & Management

Updated: Jan 27, 2021
  • Author: Bruce A Gleason, MD; Chief Editor: Duane C Caneva, MD, MSc  more...
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Approach Considerations

Treatment of staphylococcal enterotoxin B (SEB) illness is supportive:

  • In the event of dehydration, vigorous administration of intravenous fluids is indicated.

  • For patients exposed via inhalation, supportive treatment with humidified oxygen may be all that is necessary, although significant exposure may dictate intubation and assisted ventilation with high oxygen concentrations.

  • The efficacy of steroids in SEB-induced pulmonary edema or acute respiratory distress syndrome (ARDS) has not been demonstrated.


Emergency Department Care

Treatment of staphylococcal enterotoxin B (SEB) illness is limited to supportive care, with special attention to elimination of hypotension and hypoxia and pain control as needed. [2, 22]  Options are as follows:

  • Cough suppressants and acetaminophen for fever will make the patient more comfortable.
  • Antiemetics should be provided for nausea in food poisoning as necessary.
  • Mechanical ventilation may be required in severe cases.
  • Vasopressors and diuretics may be required in severe cases.
  • Antibiotics have not demonstrated efficacy in SEB intoxication, and steroids have not been shown to be effective in SEB-induced pulmonary edema.
  • The mainstay of treatment should be directed towards sepsis and septic shock.
  • Dexamethasone, or even doxycycline, may have a role as adjunctive therapy; both have been shown, in in vitro and mice studies, to downregulate the cytokine response during infection with SEB. [23, 24]


Consultations are dictated by the patient's physiologic condition, as follows:

  • If a terrorist attack using SEB is suspected, expeditiously inform local law enforcement personnel, including the local Federal Bureau of Investigation.

  • In the event that a cluster of patients present with similar symptoms, either of pulmonary or GI origin, notify local public health officials to begin epidemiologic investigation.