title: Antibiotic treatment of verocytotoxin-producing Escherichia coli (VTEC) infection: a systematic review and a proposal.
abstract: OBJECTIVE
  A consensus has existed on not to treat verocytotoxin-producing Escherichia coli (VTEC)-infected individuals with antibiotics because of possible subsequent increased risk of developing haemolytic uraemic syndrome (HUS). The aim of this systematic review is to clarify the risk associated with antibiotic treatment during acute VTEC infection and in chronic VTEC carrier states.
  
  
  METHODS
  A systematic search in PubMed identified 1 meta-analysis, 10 clinical studies and 22 in vitro/in vivo studies.
  
  
  RESULTS
  Four clinical studies found an increased risk of HUS, four studies found no altered risk of HUS and two studies found a protective effect of antibiotics. In vitro and clinical studies suggest that DNA synthesis inhibitors should be avoided, whereas evidence from in vitro studies indicates that certain protein and cell wall synthesis inhibitors reduce the release of toxins from VTEC isolates. Overall, these studies provide a more nuanced view of the diversity of responses by VTEC strains to antibiotics.
  
  
  CONCLUSIONS
  Based on these data, as well as data from the Danish cohort of registered VTEC infections, we propose that antibiotic treatment with protein and cell wall synthesis inhibitors can be considered when specific criteria regarding patient group, serotype, virulence profile and duration of disease are met.
authors.affiliation: Department of Internal Medicine, Trelleborg Hospital, Trelleborg, Sweden.
authors.forename: Morten
authors.initials: M
authors.lastname: Agger
authors.affiliation: WHO Collaborating Centre for Reference and Research on Escherichia and Klebsiella, Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark.
authors.forename: Flemming
authors.initials: F
authors.lastname: Scheutz
authors.affiliation: WHO Collaborating Centre for Reference and Research on Escherichia and Klebsiella, Department of Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark.
authors.forename: Steen
authors.initials: S
authors.lastname: Villumsen
authors.affiliation: Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen, Denmark.
authors.forename: Kåre
authors.initials: K
authors.lastname: Mølbak
authors.affiliation: Department of Gastroenterology, Hvidovre University Hospital, 2650 Hvidovre, Denmark Department of Clinical Microbiology, Hvidovre University Hospital, 2650 Hvidovre, Denmark andreas.munk.petersen@regionh.dk.
authors.forename: Andreas Munk
authors.initials: AM
authors.lastname: Petersen
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D004927:Escherichia coli Infections / Q000150:complications* / Q000188:drug therapy* / Q000382:microbiology; D006463:Hemolytic-Uremic Syndrome / Q000139:chemically induced*; D006801:Humans; D054323:Shiga-Toxigenic Escherichia coli / Q000187:drug effects*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents