From the Guidelines

Yes, clindamycin plays a role in decreasing toxin production in toxic shock syndrome (TSS).

Clindamycin suppresses toxin and cytokine production, which is beneficial in the treatment of TSS, particularly in cases caused by group A streptococci 1 and Staphylococcus aureus, including community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) 1.

The Infectious Diseases Society of America recommends the use of clindamycin in combination with penicillin for the treatment of necrotizing fasciitis and streptococcal toxic shock syndrome caused by group A streptococci, as clindamycin has been shown to be superior to penicillin in animal models and observational studies 1.
The Surviving Sepsis Campaign suggests the use of clindamycin for toxic shock syndromes with refractory hypotension, particularly in children who are more prone to toxic shock due to their lack of circulating antibodies to toxins 1.

Clindamycin should be used in combination with other antibiotics, such as penicillin, to ensure adequate coverage and prevent resistance 1.
The use of clindamycin may be beneficial in severe infections, including those caused by CA-MRSA, where toxin production is a major contributor to disease severity 1.

From the Research

Clindamycin has been shown to suppress the expression of virulence factors in Staphylococcus aureus, including toxic-shock-staphylococcal toxin (TSST-1) 2.
The use of clindamycin has been advocated for the treatment of toxic shock syndrome (TSS) due to its ability to inhibit exotoxin production 3.
Clindamycin has been found to decrease TSST-1 production in both logarithmic and stationary phases of growth, although its bacteriostatic action may be a disadvantage in overwhelming infections 3.
Experimental laboratory evidence suggests that clindamycin may be useful as an adjunctive treatment for streptococcal and staphylococcal infections complicated by toxin production 4.
A transgenic model of staphylococcal soft tissue infection found that clindamycin-containing antibiotic regimens reduced abscess size and TSST-1 production, highlighting a potential role for adjunctive clindamycin in the treatment of TSS 5.
A systematic review and meta-analysis found a statistically significant association between clindamycin treatment and reduced mortality in streptococcal toxic shock syndrome (STSS) patients, although the certainty of evidence was low 6.

Clindamycin is a protein synthesis inhibitory agent that modulates virulence expression at sub-inhibitory concentrations (sub-MICs) in clindamycin-susceptible S. aureus strains 2.
Clindamycin has been shown to decrease the expression of various virulence factors, including Panton-Valentine leucocidin, TSST-1, and alpha-haemolysin (Hla) 2.
The combination of flucloxacillin and gentamicin has been found to inhibit TSST-1 production and exert high bactericidal activity, making it a potential alternative to clindamycin for the treatment of exotoxin-mediated diseases 3.

Clindamycin may be considered as an adjunctive treatment for TSS, particularly in cases where toxin production is a concern 4, 5.
The use of clindamycin in combination with other antibiotics, such as flucloxacillin and gentamicin, may be beneficial in reducing toxin production and improving outcomes in TSS patients 3, 5.
Further research is needed to fully understand the role of clindamycin in the treatment of TSS and to determine the optimal treatment regimens for this condition 6.