A systematic review of 10 studies 1 (of which two were small RCTs and the rest were observational studies) including a total of 688 patients found that in children with suspected HUS the relative risk of progressive haemolytic uraemic syndrome or sepsis was 1.15 (95% CI 0.79 to 1.68) in those who received antibiotics compared to those who were withheld antibiotics.
The most publicized study included in the systematic review: Among 71 children with E. coli O157:h7 diarrhoea, the haemolytic - uraemic syndrome developed in 5 of the 9 who received antibiotics (56%), but only in 5 of the 62 children who had not received antibiotics (8%) 2. The clinical and laboratory characteristics of the children who received antibiotics were similar to those of the children who did not receive antibiotics. In multivariate analysis that was adjusted for the initial white-cell count and the day of illness on which stool was obtained for culture, antibiotic administration remained a risk factor for the development of the syndrome (relative risk 17.3, 95% CI 2.2 to 137).
Comment: The quality of evidence is downgraded by study limitations, inconsistency in results, and there the possibility of publication bias. The authors conclude that antibiotics may not be indicated in children with the typical picture of HUS, but if the patient has a clinical presentation of severe sepsis (where antibiotics are generally indicated) with features of HUS, antibiotics should be given.
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