Table 2 Interventions for the prevention of HUS in human STEC infection
From: Interventions for preventing diarrhea-associated hemolytic uremic syndrome: systematic review
SR/RCT | Population | Intervention | Outcome | Results | ||
|---|---|---|---|---|---|---|
Systematic reviews | ||||||
Safdar 2002 [43] 9 studies | Patients with E. coli 0157: H7 enteritis, some developing HUS | Antibiotics | Development of HUS | Meta-analysis showed neither protection nor increased risk of HUS with antibiotics. Pooled odds ratio 1.15 (95% CI 0.79-1.68) | ||
Panos 2006 [44] 19 studies with no meta-analysis | Patients with E. coli 0157: H7 enteritis | Antibiotics | Development of HUS and duration/severity of enteritis | Inconclusive: concluded that more studies were required to determine effect of antibiotics on duration and severity of enteritis, and development of HUS | ||
Randomised controlled trials | AR of HUS | AR reduction (NNT to prevent HUS) | Relative risk | |||
Treatment vs control | (95% CI) | |||||
Proulx 1992 RCT [46] | Children with diarrhoea and E. coli 0157: H7 isolated in stool. Mean age 64 months (range 3–213 months). N = 47 (Intervention group n = 22; no treatment n = 25) | Trimethoprim-sulfamethoxazole (4/20 mg/kg/dose) twice daily for 5 days versus no antibiotics | Development of HUS | 9% vs 16% | 7%; (14) | 0.57 |
(0.09-3.46) | ||||||
P = 0.67 | ||||||
Rowe 1997 [47] | Children with documented E coli 0157 (or other STEC) infection, close contact with HUS or STEC infection; or symptoms of STEC infection N = 353 | Synsorb-Pk versus placebo | Development of HUS: | 5% vs 5.6% | 0.6% (167) | 0.93 |
1. All included patients (n = 353) | (0.39-2.22) | |||||
|  | 2. Patients with proven STEC infection (n = 119) | 12% vs 15% | 3% (33) | 0.76 | ||
(0.30-1.92) | ||||||
|  | 3. Patients treated <4 days from diarrhoea onset (n = 73) | 11% vs 25% | 14% (7) | 0.46 | ||
(0.15-1.35) | ||||||
Taylor 2011[48] | Children 6Â months to 18Â years presenting with bloody diarrhea at 13 clinical centres in South America (still enrolling) | Infusion of Shigamabs, monoclonal antibodies against Shiga-toxin 1 and Shiga-toxin 2, versus placebo | Safety, tolerability, efficacy, pharmacokinetics | Trial in progress | Taylor 2011 [48] | Children 6Â months to 18Â years presenting with bloody diarrhea at 13 clinical centres in South America (still enrolling) |