Effect of early oral fluoroquinolones in hemorrhagic colitis due to Escherichia coli O157:H7

Abstract

During the Sakai outbreak of Escherichia coli O157:H7 infection, which was linked to contaminated cafeteria school lunches, there were several treatment modalities with regard to antimicrobial drugs. Patient outcomes among three hospitals with different modalities were compared retrospectively. Hemolytic uremic syndrome did not develop in any of the 15 patients treated with oral fluoroquinolone therapy; however, HUS did develop in three of 15 patients treated with intravenous (i.v.) fosfomycin and in two of 12 patients treated with i.v. cefotaxime and oral fosfomycin. The results indicate that oral fluoroquinolone therapy administered within 3 days of illness is effective in preventing the development of HUS; however, prospective randomized double-blind studies on early antimicrobial therapy of O157 hemorrhagic colitis are necessary. Several antibiotics, including fluoroquinolones, were reported to induce the production or release of Shiga-like toxins (STX) from E. coli O157:H7 in vitro. Although patients were examined for fecal STX, no STX were detected in the stools of patients treated with oral fluoroquinolones. In fact, treatment with fluoroquinolones for 5 days eradicated E. coli O157 in all patients.

Escherichia coli O157:H7 in Raw Meat in Addis Ababa, Ethiopia: Prevalence at an Abattoir and Retailers and Antimicrobial Susceptibility

“…Although some studies do not advice antibiotic treatment for infections caused by such bacteria (Wong et al 2000), others suggest that disease progression may be prevented by administrating antibiotic at early stage of infection (Shiomi et al 1999). Thus, for better response, antimicrobial susceptibility test is necessary (Quinn et al 2002).…”

Isolation and characterization Shiga toxin-producing Escherichia coli from sheep and goats inJordanwith evidence of multiresistant serotype O157:H7

“…(Rubini et al, 1999) and four cases of HUS recorded in the Czech Republic where the infection vehicle was identified as non-pasteurised goat milk (Bielaszewska et al, 1997). Just as with other agents of human alimentary infections caused by Salmonella typhimurium DT 104 (Threlfall, 2002) and Campylobacter jejuni (Swartz, 2002), the STEC strains resistant to antibiotics of the first choice may complicate antimicrobial therapy whose timely application may prevent the development of life-threatening HUS in human STEC infections (Shiomi et al, 1999). Besides having clinical consequences, resistant E. coli strains of animal origin may be the source of determinants of resistance for the possible transfer to human strains (Oppegaard et al, 2001).…”

E. coli O104:H4 outbreak and haemolytic–uraemic syndrome

“…Nonetheless, sub-inhibitory levels that target DNA synthesis (ciprofloxacin/TMP-SMX) increase STX production; whilst ciprofloxacin's complete suppression of O157:H7 markedly increases levels of STX. Antibiotics targeting cell wall, 20 Prospective cohort 292 0.12 (0.02---0.75) Cimolai et al 21 Retrospective case---control 128 0.63 (0.27---1.43) Dundas et al 32 Retrospective cohort 120 1.23 (0.4---3.8) Martin et al 26 Retrospective cohort 117 9.4 (1.2---199) Higami et al 27 Retrospective control 216 NS d Shiomi et al 28 Retrospective 22 Prospective cohort 10 14.25 (3.62---56.1) h Pavia et al 23 Retrospective case---control 23 NS i Slutsker et al 29 Retrospective case---control 93 11.5 (1.4---91.8) j Ostroff et al 31 Retrospective case---control 80 3.1 (0.6---9.8) k 9.1 (NS) l Carter et al 30 Retrospective transcription and translation do not have any effect on STX levels. Based on the evidence, during this outbreak Germany's infectious diseases society recommended to avoid the use of FQ, TMP-SMX, aminoglycosides and fosfomycin in EHEC patients.…”