Use of antibiotics in suspected haemolytic-uraemic syndrome

doi:10.1136/bmj.330.7488.409

From trainee to consultant, BMJ Group offers doctors around the world tailored information, special events, learning resources and recruitment services at every step along their career path.

... by doctors, for doctors, for patients
We are open for entries!

Online learning

BMJ Learning

High-quality CME / CPD for doctors and other healthcare professionals. BMJ Learning features hundreds of accredited, peer-reviewed learning modules in text, video, and audio formats. Find out more

Courses and Qualifications

BMJ Masterclasses

BMJ Masterclasses, led by experts, help clinicians to use the latest evidence and recent guidelines in practice and meet their CPD/CME requirements. Find out more

Exam Preparation

The leading provider of online exam preparation, helping over 167,000 healthcare professionals to pass their exams. Find out more

onExamination

Search all BMJ education articles:

From

Limit by

The BMJ iPad app brings you the best of print and online, including live links to the latest news, blogs, video, and podcasts. Get the BMJ iPad app.
You can use bmj.com to help you with your continuing medical education. Find out about CME/CPD credits for BMJ articles
Keep up to date with cardiology: Access the latest cardiovascular medicine resources from across BMJ Group.
Countdown to London 2012: BMJ Group's Olympics portal highlights latest Olympics and sports medicine-themed research, comment and learning

Access to the full text of this article requires a subscription or payment. Please log in or subscribe below.

Bob Phillips (bob.phillips@doctors.org.uk), specialist registrar in paediatrics1,
Kay Tyerman, consultant paediatric nephrologist1,
Simon M Whiteley, consultant paediatric intensivist1

¹ Paediatric Intensive Care Unit, St James's Hospital, Leeds LS9 7TF

Correspondence to: B Phillips

Introduction

An 11 year old girl was admitted to our specialist paediatric intensive care unit under the joint care of paediatric intensivists and nephrologists. She had presented to her local hospital with a four day history of vomiting, diarrhoea, and becoming progressively more unwell. Initial blood tests showed acute renal failure and thrombocytopenia. We tentatively diagnosed haemolytic uraemic syndrome, although sepsis with renal dysfunction was part of the differential. These uncertainties arose because her blood film was not typical of haemolytic uraemic syndrome, she had a clotting abnormality, and we had no microbiological confirmation. Treatment with broad spectrum antibiotics was proposed. Some doubt remained about this treatment, however, because of a well publicised study suggesting that giving antibiotics to patients with Escherichia coli 0157:H7 enteritis could worsen haemolytic uraemic syndrome. We used a five step evidence based approach to address this problem.

Formulate the question

The first step in our approach was to formulate an answerable clinical question: In children with suspected haemolytic uraemic syndrome, particularly associated with E coli 0157:H7 infection, does treatment with antibiotics lead to increased morbidity, particularly progressive haemolytic uraemic syndrome …