A previously healthy 18-month-old develops bloody diarrhea followed 4 days later by pallor, decreased urine output, and irritability. Hemoglobin is 7 g/dL, platelets are 45,000/mm3, creatinine is 1.8 mg/dL, LDH is raised, and the smear shows fragmented red cells. Stool culture grows Shiga toxin producing Escherichia coli O157:H7. Which intervention is contraindicated?

• A Supportive fluid and electrolyte management
• B Dialysis if renal failure progresses
• C Careful monitoring of potassium and hypertension
• D Antibiotic therapy with trimethoprim-sulfamethoxazole ✓

Explanation

This is typical post-diarrheal hemolytic uremic syndrome, the commonest cause of acute kidney injury in early childhood. Antibiotics are avoided because they may increase Shiga toxin release from dying bacteria and are associated with a higher risk of hemolytic uremic syndrome. Antimotility agents are similarly avoided. Supportive care with careful fluid, electrolyte, and blood pressure management, and dialysis when indicated, remains the mainstay of treatment.

Reference: Nelson Textbook of Pediatrics, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.