Systematic review: are antibiotics detrimental or beneficial for the treatment of patients with Escherichia coli O157:H7 infection?
BACKGROUND
Escherichia coli O157:H7 is a foodborne pathogen causing haemorrhagic colitis, which is sometimes complicated by haemolytic uraemic syndrome or thrombotic thrombocytopenic purpura.


OBJECTIVE
To review the available evidence regarding the question of whether antibiotics are effective or harmful for the treatment of patients infected with E. coli O157:H7 infection.


METHODS
We searched in the PubMed for relevant laboratory and clinical studies published between 1982 and 2005.


RESULTS
In vitro studies have shown that most E. coli O157:H7 isolates are susceptible to various antibiotics, although certain antibiotics, especially at sublethal concentrations, have been found to increase the release of Shiga-like toxins, which have been associated with the development of haemolytic uraemic syndrome/thrombotic thrombocytopenic purpura in humans. No clinical studies have indicated that antibiotics are effective in reducing the duration of E. coli O157:H7 infection or the duration of diarrhoea or bloody diarrhoea specifically, while a few studies have supported that some antibiotics, especially quinolones and fosfomycin, may prevent the development of haemolytic uraemic syndrome or thrombotic thrombocytopenic purpura. On the other hand, there are some clinical studies that associate antibiotics with a higher risk for haemolytic uraemic syndrome and/or longer duration of diarrhoea, even with high mortality.


CONCLUSIONS
More randomized controlled trials are necessary in order to elucidate whether antibiotics are effective in reducing the morbidity and mortality of E. coli O157:H7 infection, rather than having a detrimental effect.
Panos
G Z
GZ
Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece.
Betsi
G I
GI
Falagas
M E
ME
D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D003967:Diarrhea / Q000139:chemically induced; D004927:Escherichia coli Infections / Q000188:drug therapy*; D019453:Escherichia coli O157 / Q000187:drug effects*; D005578:Fosfomycin / Q000627:therapeutic use; D006463:Hemolytic-Uremic Syndrome / Q000139:chemically induced / Q000517:prevention & control; D006801:Humans; D011697:Purpura, Thrombotic Thrombocytopenic / Q000139:chemically induced / Q000517:prevention & control; D015363:Quinolones / Q000627:therapeutic use; D022603:Shiga Toxins / Q000378:metabolism; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D015363:Quinolones; D022603:Shiga Toxins; D005578:Fosfomycin