Systematic review: are antibiotics detrimental or beneficial for the treatment of patients with Escherichia coli O157:H7 infection?
Version of Record online: 16 AUG 2006
Alimentary Pharmacology & Therapeutics
Volume 24, Issue 5, pages 731–742, September 2006
How to Cite
PANOS, G. Z., BETSI, G. I. and FALAGAS, M. E. (2006), Systematic review: are antibiotics detrimental or beneficial for the treatment of patients with Escherichia coli O157:H7 infection?. Alimentary Pharmacology & Therapeutics, 24: 731–742. doi: 10.1111/j.1365-2036.2006.03036.x
- Issue online: 16 AUG 2006
- Version of Record online: 16 AUG 2006
- Publication data Submitted 27 April 2006 First decision 11 June 2006 Resubmitted 23 June 2006 Accepted 24 June 2006
Escherichia coli O157:H7 is a foodborne pathogen causing haemorrhagic colitis, which is sometimes complicated by haemolytic uraemic syndrome or thrombotic thrombocytopenic purpura.
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.
We searched in the PubMed for relevant laboratory and clinical studies published between 1982 and 2005.
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.
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.