fosfomycin and Diarrhea

Escherichia coli O157:H7 is a foodborne pathogen causing haemorrhagic colitis, which is sometimes complicated by haemolytic uraemic syndrome or thrombotic thrombocytopenic purpura.. To review the available evidence regarding the question of whether antibiotics are effective or harmful for the treatment of patients infected with E. coli O157:H7 infection.. We searched in the PubMed for relevant laboratory and clinical studies published between 1982 and 2005.. In vitro studies have shown that most E. coli O157:H7 isolates are susceptible to various antibiotics, although certain antibiotics, especially at sublethal concentrations, have been found to increase the release of Shiga-like toxins, which have been associated with the development of haemolytic uraemic syndrome/thrombotic thrombocytopenic purpura in humans. No clinical studies have indicated that antibiotics are effective in reducing the duration of E. coli O157:H7 infection or the duration of diarrhoea or bloody diarrhoea specifically, while a few studies have supported that some antibiotics, especially quinolones and fosfomycin, may prevent the development of haemolytic uraemic syndrome or thrombotic thrombocytopenic purpura. On the other hand, there are some clinical studies that associate antibiotics with a higher risk for haemolytic uraemic syndrome and/or longer duration of diarrhoea, even with high mortality.. More randomized controlled trials are necessary in order to elucidate whether antibiotics are effective in reducing the morbidity and mortality of E. coli O157:H7 infection, rather than having a detrimental effect.

Topics: Animals; Anti-Bacterial Agents; Diarrhea; Escherichia coli Infections; Escherichia coli O157; Fosfomycin; Hemolytic-Uremic Syndrome; Humans; Purpura, Thrombotic Thrombocytopenic; Quinolones; Shiga Toxins; Treatment Outcome

There have been some reservations about the treatment of enterohemorrhagic Escherichia coli (EHEC) infection with antibiotics to prevent the occurrence of hemolytic uremic syndrome (HUS). However, the administration of antimicrobial agents for EHEC infection is under discussion. Therefore, we used an experimental mouse model to assess the advantage/disadvantage of two major antibiotics, levofloxacin (LVFX) and fosfomycin (FOM). Germ-free IQI mice were inoculated with EHEC O157 strain EDL931 or #7. Bacteria colonized feces at 10(9)-10(10) CFU/g, and Shiga toxins (STXs) were detected in the feces. From 1 day after infection, mice were assigned to LVFX (20 mg/kg) once daily or FOM (400 mg/kg) once daily. A significant decrease in overall mortality was observed after treatment of LVFX, with EHEC disappearing immediately from the feces of mice. FOM also reduced mortality for one strain, the STX level decreased gradually. LVFX exhibited higher therapeutic efficacy than FOM. Strain differences were observed in the model during the treatment.

Topics: Animals; Anti-Bacterial Agents; Anti-Infective Agents; Bacterial Toxins; Diarrhea; Disease Models, Animal; Escherichia coli Infections; Escherichia coli O157; Feces; Fosfomycin; Germ-Free Life; Humans; Levofloxacin; Mice; Ofloxacin; Shiga Toxins; Treatment Outcome

Predictive factors for the development of hemolytic uremic syndrome (HUS) were evaluated in 88 inpatients who suffered from enterohemorrhagic E. coli infections in the outbreak in Sakai, 1996. All in- and outpatients received oral or intravenous fosfomycin within acute phase of hemorrhagic colitis, and HUS complicated 1.4% of them. Persistence of bloody stools and diarrhea were longer in HUS patients than in non-HUS patients, but persistence of abdominal pain was not different in either group. Leukocytosis with leukocyte counts over 15,000/microliters and/or elevated CRP level over 2.0 mg/dl at admission, and fever and/or vomiting in the course of hemorrhagic colitis were more frequent in HUS patients than in non-HUS patients. Early intensive treatments including gammaglobulin, urinastatin, aspirin, and dipyridamole were employed in 34 high risk patients for prevention of HUS. These patients were estimated to be at risk of developing HUS because of incomplete HUS, nephropathy, elevated LDH level, thrombocytopenia, or age younger than two years old. These treatments were clinically effective.

Topics: Abdominal Pain; Adolescent; Age Factors; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Child; Diarrhea; Dipyridamole; Escherichia coli Infections; Female; Fever; Fosfomycin; gamma-Globulins; Glycoproteins; Hemolytic-Uremic Syndrome; Humans; Kidney Diseases; Leukocyte Count; Liver Diseases; Male; Melena; Platelet Aggregation Inhibitors; Risk Factors; Sex Factors; Time Factors

Fourteen patients with purulent skin diseases were treated orally with fosfomycin (FOM) 1.5-3 g in the tablet form for 1 week to determine its efficacy and safety. The results obtained are summarized as follows. 1. The clinical efficacy rate was 71.4%. A bacteriological eradication rate of 71.4% was obtained. 2. As adverse reactions 3 patients experienced diarrhea and abdominal pain. But in all of these patients, symptoms were relieved with a reduction in dosage. 3. Taking the efficacy and the safety into account, utility rate was assessed to be 71.4%. From these results it is considered that FOM tablets are useful equally to conventional FOM capsules.

Topics: Adolescent; Adult; Aged; Bacteria; Bacterial Infections; Capsules; Diarrhea; Drug Evaluation; Female; Fosfomycin; Humans; Male; Middle Aged; Pain; Skin Diseases, Infectious; Tablets