Use of antibiotics in suspected haemolytic-uraemic syndrome

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Abstract
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.