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Antibiotic treatment of Shiga toxin-producing E. coli requires more research
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Antibiotic treatment of Shiga toxin-producing Escherichia coli treatment requires further, more in-depth research, according to study findings in The Pediatric Infectious Disease Journal.
The recent widespread outbreak of Shiga toxin-producing E. coli (STEC) affected nearly 4,000 patients, of which 855 developed hemolytic-uremic syndrome (HUS) and 53 died. Therefore, Meirav Mor, MD, of Schneider Children’s Medical Center, and colleagues reviewed recent literature to investigate causes behind the outbreak, specifically the apparent antibiotic resistance of treatment.
Meirav Mor
The researchers came up with the following conclusions and recommendations regarding STEC infection and its treatment:
- The effect antimicrobial treatment of STEC has on one’s risk for developing hemolytic-uremic syndrome is inconclusive, yet appears to be linked to specific antibiotics used and specific pathogens involved;
- A prospective, randomized study, preferably a multi-center effort, is needed to explain this unusual issue;
- WHO does not recommend treating patients suspected to have STEC with antimicrobials;
- In sporadic cases of bloody diarrhea, infections other than STEC should be considered;
- Antimicrobial treatment is highly effective in treating shigellosis; it significantly reduces duration of diarrhea, fever, and transmissibility, because of this, STEC should be considered according to the presence of high fever, toxicity, and local epidemiologic data. Antibiotics should be considered on an individual basis;
- In vitro studies should be used to make rapid determinations of the antibiotic effects on toxin production by the causative agent.
“Antibiotics may theoretically increase the risk of HUS by killing the normal gut flora, especially when the STEC strain is resistant to the antimicrobial agent administered, as happened with the epidemic strain that originated in Germany in 2011, which contained extended spectrum beta lactamase-encoding genes…It seems that only a well-designed randomized controlled trial can resolve this controversial issue,” researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.
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