UMEM Educational Pearls

Category: Pediatrics

Title: Antibiotics for pediatric bloody stools? (submitted by Jonathan Hoover, MD)

Keywords: E. coli, O0157:H7, hematochezia, diarrhea (PubMed Search)

Posted: 9/26/2014 by Mimi Lu, MD
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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.

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.


Bottom line: Avoid treating pediatric hemorrhagic diarrhea with antibiotics



1. Systematic review: are antibiotics detrimental or beneficial for the treatment of patients with Escherichia coli O157:H7 infection? Alimentary Pharmacology & Therapeutics. Volume 24Issue 5pages 731–742September 2006

2. Risk factors for the hemolytic uremic syndrome in children infected with Escherichia coli O157:H7: a multivariable analysis. Clin Infect Dis. 2012 Jul;55(1):33-41. doi: 10.1093/cid/cis299. Epub 2012 Mar 19.