Are antibiotics necessary for hemolytic uremic syndrome?
Hemolytic uremic syndrome sometimes develops with pneumococcal infections, but it is most often caused by the action of a Shiga-type toxin produced by certain strains of Escherichia coli (in particular E. coli O157: H7) that cause diarrhea.
Hemolytic uremic syndrome (HUS) sometimes develops with pneumococcal infections, but it is most often caused by the action of a shiga-like toxin produced by certain strains of Escherichia coli ( in particular E.coli O157: H7) causing diarrhea.
Currently, it is generally recognized that antibiotics are indicated for the treatment of HUS associated with pneumococcal infections, but the opinions of experts regarding their use in HUS due to strains of Escherichia coli are contradictory. Can antibiotics cause massive release of endotoxin from E.coli dead cells? Unlikely. Can antibiotics stimulate the production of toxins by viable Escherichia coli cells? Perhaps, in any case, this has been demonstrated in experimental models of this disease in animals. Sub-therapeutic doses of various antibiotics stimulate the function of bacteriophages, which modulate the production of toxin in E. coli. Retrospective studies of the use of antibiotics in HUS in humans have led to conflicting results and have certainly shown no benefit or harm from the use of these drugs in this condition. A prospective study suggested that antibiotics could serve as "catalysts" for the development of HUS, but the number of patients in this study was too small for its results to be considered statistically significant.
Researchers from the University of Wisconsin conducted a meta-analysis of published reports of HUS cases, in which special attention has been given to the prior or concomitant use of antibiotics in this condition. The results of a meta-analysis published in the Journal of the American Medical Association - JAMA, showed that antibiotics have neither a positive nor negative effect on the occurrence of HUS. Unfortunately, this study did not allow us to assess the possible relationship between the use of antibacterial drugs and the severity of HUS.
It should be noted that although meta-analyzes of data in recent years have been a very popular research method in the practice of so-called "evidence-based medicine", or "evidence-based medicine" , this method of analysis has been severely criticized by the famous (now deceased) epidemiologist A. Feinsteein. The main reason to criticize the meta-analysis method is, first of all, the high probability of problems related to the inaccuracy of the published information, the bias in the research results in the publication process, a certain degree of bias for researchers who research and analyze the results of published studies.
Therefore, an article published in JAMA is accompanied by a detailed editorial comment, which noted that many physicians are likely to disagree with the conclusion of the meta-analysis and will continue to adhere to the tactics of HUS therapy. based on their clinical experience. According to the JAMA editorial board, there is currently no significant evidence of the benefits of using antibacterial drugs for the prevention or treatment of HUS, in addition, there are experimental data and theoretical justifications that indicate their possible adverse effect on the occurrence and course of this disease. With this in mind, antibiotics should not be used for HUS caused by E. coli.