Using antibiotics in suspected haemolytic-uraemic syndrome

EDITOR-By uncritically quoting the meta-analysis of Safdar et al in their evidence based case report, Phillips et al perpetuate an error about antibiotic treatment of Escherichia coli O157:H7 infections. 1 2 Specifically, Safdar et al mischaracterised a study by Ikeda et al as showing that treatment of E coli O157:H7 infections with fosfomycin diminished the risk of haemolytic-uraemic syndrome compared with no antibiotic treatment. 3 However, Ikeda et al did not show that antibiotics prevent the syndrome because two of the 256 patients were not treated. [...]statistically significant benefit emerged only after subgroup analysis, with the implication that treatment had value only if started on day 2 of illness.