A 4-year-old child presents on day 2 of bloody diarrhea. Stool culture is pending and EHEC O157:H7 is suspected clinically. Which management decision is specifically recommended to reduce the risk of hemolytic uremic syndrome in this child?
- A Start empiric ciprofloxacin immediately to shorten bacterial shedding
- B Avoid antibiotics and avoid antimotility agents such as loperamide ✓
- C Give a single dose of azithromycin and start oral rehydration
- D Start prophylactic plasma exchange to prevent thrombotic microangiopathy
Correct answer: B. Avoid antibiotics and avoid antimotility agents such as loperamide
Explanation
Antibiotics are avoided in suspected EHEC infection because evidence suggests they increase release of Shiga toxin from dying bacteria and may raise the risk of HUS. Antimotility agents prolong toxin exposure by delaying gut clearance and are also contraindicated. Management is supportive with careful hydration and monitoring for anemia, thrombocytopenia and renal impairment. Plasma exchange has no proven preventive role in typical diarrhea-associated HUS, which is managed supportively once established.
Reference: Harrison Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.