Effect of early oral fluoroquinolones in hemorrhagic colitis due to Escherichia coli O157:H7
Effect of early oral fluoroquinolones in hemorrhagic colitis due to Escherichia coli O157:H7. Shiomi M, Togawa M, Fujita K, Murata R. Pediatrics International 1999;41(2):228-232.
This study evaluated an outbreak of Escherichia coli O157:H7 infection linked to contaminated cafeteria school lunches in Sakai, Osaka, Japan. Patient outcomes were compared among three hospitals with regard to antimicrobial drugs used. Hemolytic uremic syndrome (HUS) did not develop in any of the 15 patients treated with oral fluoroquinolone therapy; however, HUS did develop in three of 15 patients treated with intravenous fosfomycin and in two of 12 patients treated with intravenous cefotaxime and oral fosfomycin. The results suggested that oral fluoroquinolone therapy administered within three days of illness was effective in preventing the development of HUS. Several antibiotics, including fluoroquinolones, have been reported to induce the production or release of Shiga-like toxins (STX) from E. coli O157:H7 in vitro. Although patients were examined for fecal STX, no STX were detected in the stools of patients treated with oral fluoroquinolones. In fact, treatment with fluoroquinolones for five days eradicated E. coli O157 in all patients. Prospective randomized double-blind studies on early antimicrobial therapy of E. Coli O157:H7 hemorrhagic colitis were recommended by the authors.