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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 6 months to 18 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 6 months to 18 years presenting with bloody diarrhea at 13 clinical centres in South America (still enrolling)
  1. RCT randomised controlled trial; SR systematic review; AR absolute risk; NNT number needed to treat; CI confidence interval.