Risk of the Hemolytic–Uremic Syndrome after Antibiotic Treatment of<i>Escherichia coli</i>O157:H7 Infections
Authors: M O'Ryan, V Prado
Journal: New England Journal of Medicine (2000)

C ORR ES POND ENCE 1. Tefferi A. Myelofibrosis with myeloid metaplasia. N Engl J Med 2000; Risk of the Hemolytic–Uremic Syndrome after Antibiotic Treatment of Escherichia coli O157:H7 Infections To the Editor: Wong et al. (June 29 issue) 1 report an as- sociation between antibiotic treatment in children with acute diarrhea caused by Escherichia coli O157:H7 and the devel- opment of the hemolytic–uremic syndrome. In Chile, shi- gella species cause 30 percent of cases of bloody diarrhea in children and enterohemorrhagic strains of E. coli cause 37 percent of such cases 2 — a situation that may also be com- mon in developing countries. For children with acute bloody diarrhea in these countries, the most widely accepted rec- ommendation is to obtain a stool culture and initiate empir- ical antibiotic treatment for shigella, because appropriate treatment shortens the duration of the diarrhea, decreases the incidence of complications, and reduces the risk of trans- mission by shortening the duration of bacterial shedding. 3 Given these points, the results presented by Wong et al. raise several questions. Knowing that E. coli O157:H7 and shigella species cannot be differentiated early in the clinical course on the basis of clinical findings or simple laboratory tests, does the potentially increased risk of the hemolytic– uremic syndrome associated with empirical antibiotic treat- ment of E. coli O157:H7 infections outweigh the risk of not treating shigella infections during the 72 hours need- ed to obtain culture results? In Chile, 70 percent of cases of the hemolytic–uremic syndrome are associated with se- rotypes of E. coli other than O157:H7. 4 Can the increased risk of the hemolytic–uremic syndrome in children who receive antibiotics for E. coli O157:H7 infections be extrap- olated to other strains of the organism? We worry that the message of this study will be extended prematurely to the treatment of bloody diarrhea worldwide. In places where the prevalence of shigella and E. coli infec- tions is similar and strains of E. coli other than O157:H7 are common, withholding antibiotic therapy until the cause of the diarrhea is known may have more risks than benefits. A M IGUEL O’R YAN , M.D. V ALERIA P RADO , M.D. University of Chile Santiago, Chile B Figure 1. Lesions of the Skin (Panel A) and Mouth (Panel B) in a Patient with Post-Polycythemic Myeloid Metaplasia. serious exacerbation of post-polycythemic myeloid metapla- sia in a patient who was receiving epoetin may be uncom- mon, but it is striking and should be recognized as a poten- tial sequela of such treatment. A BDUL R AHMAN J AZIEH , M.D., M.P.H. University of Cincinnati Cincinnati, OH 45267 1. Wong C, Jelacic S, Habeeb RL, Watkins SL, Tarr PI. The risk of the hemolytic–uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 infections. N Engl J Med 2000;342:1930-6. 2. Lopez EL, Prado-Jimenez V, O’Ryan-Gallardo M, Contrini MM. Shi- gella and Shiga toxin-producing Escherichia coli causing bloody diarrhea in Latin America. Infect Dis Clin North Am 2000;14:41-65, viii. 3. Haltalin KC, Nelson JD, Ring R III, Sladoje M, Hinton LV. Double- blind treatment study of shigellosis comparing ampicillin, sulfadiazine, and placebo. J Pediatr 1967;70:970-81. 4. Prado JV, Martinez DJ, Arellano CC, Levine MM. Variacion temporal de genotipos y serogrupos de E Coli enterohemorragicos aislados en ninos chilenos con infecciones intestinales o sindrome hemolitico-uremico. Rev Med Chil 1997;125:291-7. M OHAMMAD J. K YASA , M.D. University of Arkansas for Medical Sciences Little Rock, AR 72205 To the Editor: We question some of the epidemiologic concepts and analyses used by Wong et al. They justified the Vol ume 343 The New England Journal of Medicine Downloaded from nejm.org at Berkeley (UCB) on February 19, 2017. For personal use only. No other uses without permission. Copyright © 2000 Massachusetts Medical Society. All rights reserved. Numb e r 17