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

• Published in: Pediatrics international Vol. 41; no. 2; pp. 228 - 232
• Main Authors: Shiomi, Masashi, Togawa, Masao, Fujita, Keinosuke, Murata, Ryousuke
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Science Asia Pty. Ltd 01.04.1999
• Subjects: Administration, Oral; Anti-Infective Agents - administration & dosage; Anti-Infective Agents - therapeutic use; Bacterial Toxins - analysis; Child; Colitis - drug therapy; Colitis - etiology; Colitis - microbiology; Escherichia coli Infections - drug therapy; Escherichia coli Infections - pathology; Escherichia coli O157 - pathogenicity; Escherichia coli O157:H7; Female; Fluoroquinolones; Gastrointestinal Hemorrhage - drug therapy; Gastrointestinal Hemorrhage - etiology; Gastrointestinal Hemorrhage - microbiology; hemolytic uremic syndrome; Hemolytic-Uremic Syndrome - drug therapy; Hemolytic-Uremic Syndrome - etiology; Hemolytic-Uremic Syndrome - microbiology; hemorrhagic colitis; Humans; Male; Retrospective Studies; Shiga-like toxin; Treatment Outcome
• ISSN: 1328-8067; 1442-200X
• DOI: 10.1046/j.1442-200X.1999.4121038.x

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.