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<DIV style="MARGIN-LEFT: 1em; MARGIN-RIGHT: 1em"><A
href="http://www.latimes.com/news/local/la-me-antibiotics11dec11,0,36929.story?track=tothtml">http://www.latimes.com/news/local/la-me-antibiotics11dec11,0,36929.story?track=tothtml</A><BR>
<H1>CDC warns against antibiotics for E. coli</H1>
<DIV class=storysubhead>Children treated with the drugs can become much more
seriously ill, the health agency says.</DIV>By Mary Engel<BR>Times Staff
Writer<BR><BR>December 11, 2006<BR><BR>With back-to-back outbreaks of a
potentially deadly strain of <I>Escherichia coli </I>— one traced to California
spinach in September and now another linked to products sold by Taco Bell — some
experts are renewing warnings against treating the symptoms with
antibiotics.<BR><BR>For at least five years, the federal Centers for Disease
Control and Prevention, the American Medical Assn. and other medical groups have
advised against using antibiotics because of evidence that they can make
patients sicker. <BR><BR>But some doctors still prescribe antibiotics because
they are unaware of the advice, misdiagnose the still-rare <I>E. coli
</I>O157:H7 or don't find the relationship between antibiotics and greater
medical risk convincing.<BR><BR>The studies exist, "but I don't know how well
known they are," said Dr. David Acheson, chief medical officer in the Food and
Drug Administration's food safety center and one of several experts to warn
against antibiotic use in treating the <I>E. coli </I>strain.<BR><BR>A 2000
study found that children infected by <I>E. coli O</I>157:H7 and given
antibiotics developed a life-threatening complication called hemolytic uremic
syndrome at higher rates than children who did not take antibiotics. The
syndrome is the leading cause of kidney failure in children.<BR><BR>It is
unclear whether antibiotics have contributed to the severity of the spinach- and
Taco Bell-related outbreaks. A Riverside County couple believes, however, that
the drugs endangered the life of their 7-year-old son, whose infection with
<I>E. coli </I>O157:H7 may be linked to unpasteurized milk from a Fresno dairy.
<BR><BR>When Tony and Mary Martin rushed their son, Sam, to a Riverside hospital
in September, the first doctor they saw suspected <I>E. coli </I>and warned
against using antibiotics to treat the boy's severe abdominal cramps and bloody
diarrhea.<BR><BR>In the five days it took to get lab tests back on Sam's stool
sample, the boy changed hospitals and physicians, and he was given the
antibiotics Flagyl and Claforan.<BR><BR>Within hours, Tony Martin said, Sam's
kidneys shut down. He spent two months in the hospital.<BR><BR>"This could have
been prevented with a 3-cent band on his wrist that said, 'No antibiotics,' "
Tony Martin said.<BR><BR>California and nine other states are taking part in a
study by the CDC to help settle the antibiotic question. Preliminary results are
expected by summer 2007.<BR><BR>"No one knows for sure whether antibiotics are a
risk factor," said Dr. Linda Demma, a CDC epidemiologist. "Different doctors
will do different things, since the literature is inconclusive so far. We're
hoping to prove it one way or the other."<BR><BR>Scientists who have studied the
link aren't waiting for further confirmation to preach restraint.<BR><BR>"It's
kind of like aspirin and Reyes syndrome," said Dr. Phillip Tarr, professor of
pediatric gastroenterology at Washington University in St. Louis and an author
of the 2000 study. "No one ever did a control study that proved aspirin causes
Reyes syndrome. But none of us will give aspirin for chicken
pox."<BR><BR>Patients suspected of being infected with <I>E. coli </I>should be
hospitalized and given intravenous hydration, he said. <BR><BR>The CDC
discourages giving antibiotics for diarrhea in general because it promotes
antibiotic resistance and because most people recover without treatment. Some
doctors, however, prescribe antibiotics for a less dangerous <I>Shigella
</I>bacteria because antibiotics reduce the amount of bacteria shed in stools
and allow children to return to day care with less chance of infecting
others.<BR><BR><I>E. coli </I>O157:H7 is a nasty bug, apart from how it's
affected by antibiotics. Like the toxin ricin, which causes similar symptoms
when ingested, <I>E. coli </I>O157:H7 is on the nation's list of possible
substances that could be used in bioterrorism attacks. <BR><BR>It is one of
hundreds of strains of <I>E. coli, </I>usually a relatively harmless bacterium
found in the intestinal tracts of cattle and other animals. The more potent
strain first attracted notice in 1982, when 47 people became ill after eating
undercooked fast-food hamburgers. <BR><BR>What sets this version apart from the
more benign versions is its ability to produce potentially lethal toxins. The
theory goes that as antibiotics attack the bacterium, the toxins begin
replicating and burst into the body.<BR><BR>"When I was in academia," the FDA's
Acheson said, "it was part of my mantra to talk about the dangers of antibiotic
use."<BR><BR>Not everyone who takes antibiotics gets worse. And some develop
hemolytic uremic syndrome without taking antibiotics. CDC scientists believe
that the unusually high proportion of people in the spinach outbreak who were
hospitalized or developed the syndrome was probably the result of a particularly
lethal sub-type of <I>E. coli </I>O157:H7. They also think that the spinach may
have been especially heavily contaminated with <I>E. coli.</I><BR><BR>Two
elderly women and a 2-year-old child died in the spinach outbreak last
September, which sickened more than 200 people in 26 states.<BR><BR>As of
Sunday, the CDC said, 61 people with illness associated with the Taco Bell
outbreak, which might be linked to California-grown green onions, have been
reported in five states. <BR><BR>The Martins believe that Sam contracted a
strain of <I>E. coli </I>from raw milk. State health officials investigating
four other cases of <I>E. coli </I>in September found that the only thing the
sick children had in common was that they had drunk raw milk from Organic
Pastures Dairy Co. Their investigation is ongoing.<BR><BR>The sub-strain of
O157:H7 found in the children's stool samples was different from the spinach
sub-strain. <BR><BR>Of the five children who drank raw milk and got sick, three
who recovered fairly quickly were not treated with antibiotics. Sam and a girl
from San Bernardino County were, and both developed hemolytic uremic
syndrome.<BR><BR>The girl went home from the hospital in October, Sam in
November. Most children with the syndrome recover completely, but Sam Martin
will need to be monitored for long-term kidney damage and other complications.
<BR><BR>*<BR><BR>
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<I>mary.engel@latimes.com</I></DIV></FONT></DIV></BODY></HTML>