Title: Antibiotics for pediatric boody stools? (submitted by Jonathan Hoover, MD)<br/>Author: Mimi Lu<br/><a href='http://umem.org/profiles/faculty/185/'>[Click to email author]</a><hr/><p>
There are numerous different causes of pediatric hemorrhagic diarrhea. Consider a pediatric patient with bloody diarrhea as being at risk for developing hemolytic uremic syndrome. Most cases of hemolytic uremic syndrome are caused by O157:H7 strains of E Coli that release Shiga-like toxin from the gut. Systemic release of the toxin causes microvascular thromboses in the renal microvasculature. The characteristic microangiopathic hemolysis results with anemia, thrombocytopenia and peripheral schistocytes seen on laboratory studies, in addition to acute renal failure.</p>
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Antibiotics have been controversial in the treatment of pediatric hemorrhagic diarrhea due to concern that they worsen toxin release from children infected with E Coli O157:H7 and thus increase the risk of developing hemolytic uremic syndrome. Numerous previous studies have provided conflicting data regarding the true risk (1). A recent prospective study showed antibiotic treatment increases the risk (2). Most recommendations warn against using antibiotics to treat pediatric hemorrhagic diarrhea unless the patient is septic.</p>
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<em><strong><u>Bottom line</u></strong></em>: Avoid treating pediatric hemorrhagic diarrhea with antibiotics</p>
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References:</p>
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<span style="font-size:11px;">1. <span style="color: rgb(0, 0, 0); font-family: Arial,'Lucida Grande',Geneva,Verdana,Helvetica,'Lucida Sans Unicode',sans-serif; font-weight: bold; line-height: 14px;">Systematic review: are antibiotics detrimental or beneficial for the treatment of patients with </span><em style="margin:0px;padding:0px;border:0px;outline:0px;font-size:14px;vertical-align:baseline;font-weight:bold;color:rgb(0,0,0);font-family:Arial,'Lucida Grande',Geneva,Verdana,Helvetica,'Lucida Sans Unicode',sans-serif;line-height:14px">Escherichia coli</em><span style="color: rgb(0, 0, 0); font-family: Arial,'Lucida Grande',Geneva,Verdana,Helvetica,'Lucida Sans Unicode',sans-serif; font-weight: bold; line-height: 14px;"> O157:H7 infection? </span><span style="color: rgb(93, 93, 93); font-family: Arial,'Lucida Grande',Geneva,Verdana,Helvetica,'Lucida Sans Unicode',sans-serif; line-height: 1.2em;">Alimentary Pharmacology & Therapeutics. </span><a href="http://onlinelibrary.wiley.com/doi/10.1111/apt.2006.24.issue-5/issuetoc" shape="rect" style="margin:0px;padding:0px;border:0px;outline:0px;font-size:12px;vertical-align:baseline;text-decoration:none;color:rgb(0,126,138);font-family:Arial,'Lucida Grande',Geneva,Verdana,Helvetica,'Lucida Sans Unicode',sans-serif;line-height:15.600000381469727px" target="_blank"><span style="margin: 0px; padding: 0px; border: 0px none; outline: 0px none; vertical-align: baseline; background-color: transparent; color: rgb(0, 126, 139); font-weight: bold;">Volume 24</span>, <span style="margin: 0px; padding: 0px; border: 0px none; outline: 0px none; vertical-align: baseline; background-color: transparent; color: rgb(0, 126, 139); font-weight: bold;">Issue 5</span>, </a><span style="margin: 0px; padding: 0px; border: 0px none; outline: 0px none; vertical-align: baseline; color: rgb(0, 126, 139); font-weight: bold; font-family: Arial,'Lucida Grande',Geneva,Verdana,Helvetica,'Lucida Sans Unicode',sans-serif; line-height: 15.6px;">pages 731–742</span><span style="color: rgb(163, 162, 162); font-family: Arial,'Lucida Grande',Geneva,Verdana,Helvetica,'Lucida Sans Unicode',sans-serif; line-height: 15.6px;">, </span><span style="margin: 0px; padding: 0px; border: 0px none; outline: 0px none; vertical-align: baseline; color: rgb(0, 126, 139); font-weight: bold; font-family: Arial,'Lucida Grande',Geneva,Verdana,Helvetica,'Lucida Sans Unicode',sans-serif; line-height: 15.6px;">September 2006</span></span></p>
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<span style="font-size:11px;"><span style="margin: 0px; padding: 0px; border: 0px none; outline: 0px none; vertical-align: baseline; color: rgb(0, 126, 139); font-weight: bold; font-family: Arial,'Lucida Grande',Geneva,Verdana,Helvetica,'Lucida Sans Unicode',sans-serif; line-height: 15.6px;">2. </span><span style="color: rgb(0, 0, 0); font-family: arial,helvetica,clean,sans-serif; line-height: 1.125em;">Risk factors for the hemolytic uremic syndrome in children infected with Escherichia coli O157:H7: a multivariable analysis. </span><span style="color: rgb(0, 0, 0); font-family: arial,helvetica,clean,sans-serif; line-height: 15.9565px;"><a href="http://www.ncbi.nlm.nih.gov/pubmed/22431799#" style="color:rgb(102,0,102);border-bottom-width:0px" target="_blank" title="Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.">Clin Infect Dis.</a> 2012 Jul;55(1):33-41. doi: 10.1093/cid/cis299. Epub 2012 Mar 19.</span></span></p>