Why antibiotics should not be used to treat Shiga toxin-producing Escherichia coli infections

Abstract

Purpose of reviewThere has been much debate about treating Shiga toxin-producing Escherichia coli (STEC) infections with antibiotics. No data convincingly demonstrate that antibiotics are better than no antibiotic treatment at all, and many studies suggest antibiotics increase the risk of developing the hemolytic uremic syndrome (HUS). This topic is timely, because emerging technology enables rapid identification of STEC-infected patients, and we anticipate questions about management will increase. This review is designed to familiarize readers with the series of observations that underlie our recommendations. Recent findingsThe long debate over antibiotics in STEC infections appears resolved by gradually accruing information that show that antibiotics do not benefit infected patients. In fact, they are associated with an increased likelihood of developing HUS. A meta-analysis published in 2016 demonstrated that low risk of bias studies find a clear association between antibiotic use and development of HUS. Subsequent publications do not refute these findings.

Enteric Pathogen Testing Importance for Children with Acute Gastroenteritis: a Modified Delphi Study

“…However, targeted use in children with symptoms and history that potentially match several pathogens could improve their utility and reduce the likelihood of incidental findings ( 35 ). If used, multiplex panels should be coupled with established diagnostic stewardship strategies ( 36 ), including annotation of pathogens not likely to benefit from antimicrobial treatment (e.g., STEC [ 12 , 37 ] and Salmonella [ 11 ]). In addition, selective suppression of results likely to indicate colonization (e.g., C. difficile in children <2 years old [ 38 , 39 ] and EPEC in high-income settings [ 40 , 41 ]) can prevent unnecessary treatment of these conditions.…”

Plant-derived nanoparticles as alternative therapy against Diarrheal pathogens in the era of antimicrobial resistance: A review

“…Unfortunately, a large proportion of individuals suffering from Diarrhea rarely report cases to hospitals but rather resorts to self-medication (Ferdous, 2018). This practice has been highly discouraged especially if the causative agent is E. coli strain belongs to the STEC serotype O157:H7 (Hwang et al, 2021;Ramstad et al, 2021;Tarr and Freedman, 2022). Antibiotic therapy is contraindicated in the treatment and management of Diarrhea infections caused by STEC because there is evidence that antibiotics may increase the risk of developing more life threatening complications, such as haemolytic uremic syndrome (HUS), haemorrhagic colitis, and thrombotic thrombocytopenic purpura (TTP) that have all been associated with renal failure (Hwang et al, 2021;Ramstad et al, 2021;Tarr and Freedman, 2022).…”

“…This practice has been highly discouraged especially if the causative agent is E. coli strain belongs to the STEC serotype O157:H7 (Hwang et al, 2021;Ramstad et al, 2021;Tarr and Freedman, 2022). Antibiotic therapy is contraindicated in the treatment and management of Diarrhea infections caused by STEC because there is evidence that antibiotics may increase the risk of developing more life threatening complications, such as haemolytic uremic syndrome (HUS), haemorrhagic colitis, and thrombotic thrombocytopenic purpura (TTP) that have all been associated with renal failure (Hwang et al, 2021;Ramstad et al, 2021;Tarr and Freedman, 2022). This supports the view to ensure that appropriate tests are conducted to correctly determine the identities of causative agents before antibiotic therapy.…”

Enterohemorrhagic Escherichia coli and a Fresh View on Shiga Toxin-Binding Glycosphingolipids of Primary Human Kidney and Colon Epithelial Cells and Their Toxin Susceptibility

“…The administration of antibiotics in EHEC infections was and remains controversial because of concerns about triggering HUS by increasing Stx production [285][286][287]. Stxs are encoded by genes located on genomes of lambdoid prophages and certain antibiotics stimulate their induction leading to enhanced production of Stxs [288].…”