Treatment
The effect of antibiotics in E. coli O157:H7 colitis is controversial. Certain antibiotic may stimulate further verotoxin production and thereby increase the risk of HUS. However there is also tentative evidence that some antibiotics like quinolones may decrease the risk of haemolytic uraemic syndrome.
Treatment is generally supportive, with dialysis as needed. Untreated HUS in adults, however, may progress to end-stage organ damage. Platelet transfusion may actually worsen the outcome.
In most children with postdiarrheal HUS, there is a good chance of spontaneous resolution, so observation in a hospital is often all that is necessary, with supportive care such as hemodialysis where indicated. In children with neurological or other nonrenal involvement, and in adult cases, particularly when there is diagnostic uncertainty between HUS and TTP, plasmapheresis (plasma exchange) is the treatment of choice. This is generally performed daily until the platelet count is normal, using fresh frozen plasma as the replacement fluid for the patient's plasma which is removed. Plasmapheresis may reverse the ongoing platelet consumption.
There are case reports of experimental treatments with eculizumab, a monoclonal antibody that blocks part of the complement system, being used to treat congenital atypical hemolytic uremic syndrome, as well as severe shiga-toxin associated hemolytic uremic syndrome. These have shown promising results. Eculizumab was approved by the U.S. Food and Drug Administration (FDA) for the treatment of all pediatric and adult patients with atypical hemolytic uremic syndrome (aHUS) in September 2011.
Read more about this topic: Hemolytic-uremic Syndrome
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