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Risk of hemolytic uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 enteritis

Risk of hemolytic uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 enteritis, a meta-analysis. Safdar N, Said A, Gangnon RE, Maki DG. JAMA 2002;288(8):996-1001.

ABSTRACT:

A meta-analysis of risk factors for hemolytic uremic syndrome (HUS) was undertaken to explore the association between antibiotic therapy for E. coli O157:H7 infection and the risk of HUS. Although there is no clear consensus, according to the authors, on whether antibiotics should be administered as treatment for this infection, avoidance of antibiotic therapy appears to be a growing practice. Nine studies were included that reported on a series of documented E. coli O157:H7 infection, including those with HUS, with clear definitions of HUS, adequate data on the relationship between antibiotic therapy and the occurrence of HUS, and which included a control group. Two of the studies showed a significant adverse effect of antibiotic use on HUS, five showed no association, and one reported a protective effect. Overall, there was no statistically significant association. The authors also review a number of other studies in some detail. Laboratory and animal studies have demonstrated varying effects of antibiotic exposure on toxin production by E. coli O157:H7. Some clinical studies have shown that outcomes vary by type of antibiotic used. The authors conclude that a randomized trial of adequate power, with multiple distinct strains of E. coli O157:H7 represented, is needed to determine whether antibiotic treatment increases the risk of HUS.