[The role of antibiotics in the management of verotoxin-associated hemolytic anemia syndromes]. / Zur Rolle von Antibiotika beim Management des Verotoxin-assoziierten hämolytisch-urämischen Syndroms.

ABSTRACT

Significant improvements of dialysis techniques and the supportive treatment of the hemolytic uremic syndrome (HUS) during the last three decades do not veil the fact that causal therapy is not yet feasible. This holds true for the classic HUS associated with infections by verotoxin-(VT-)producing E.coli (VTEC) as for the majority of the much less frequent "atypical" forms. The influence of antimicrobial agents on production of verotoxins produced by clinical VTEC isolates was examined. Co-trimoxazole significantly increased the total yield of toxin. In contrast, ciprofloxacin, lincomycin and gentamicin caused significant reduction in toxin yields. The pathogenetic and therapeutic relevance of this finding is not yet known. Analysis of the clinical literature for the postulated relation between antibiotic treatment and development of HUS or its impact on the severity of the disease reveals a controversial picture. Based on the dynamics of the disease, the in vitro findings, and reports on unfavourable outcomes after treatment, it is concluded that antibiotics are not indicated in most cases of the enteropathic HUS or other VTEC infections. Antibiotic prophylaxis has neither been proven to be efficacious nor safe for the prevention of secondary cases during VTEC outbreaks. Apart from the implementations of hygienic measures, prospective studies on the role of antibiotics seem clearly warranted. Possible future strategies may include the design of immunological therapeutic concepts.