Kidney Week

Abstract: TH-PO1196

Azithromycin for the Prevention of Hemolytic Uremic Syndrome in Shiga Toxin-Positive Diarrhea: A Proof of Concept

Session Information

• Late-Breaking Science Posters
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

• 1900 Pediatric Nephrology

Authors

• Ardissino, Gianluigi, Center for HUS Prevention, Control and Management, Pediatric Nephrology, Dialysis and Transplantation Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy

Gianluigi Ardissino, MD, PhD

• Dato, Letizia, Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy

Letizia Dato, MD

• Mancuso, Maria Cristina, Center for HUS Prevention, Control and Management, Pediatric Nephrology, Dialysis and Transplantation Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy

Maria Cristina Mancuso, MD

• Ria, Thomas, Center for HUS Prevention, Control and Management, Pediatric Nephrology, Dialysis and Transplantation Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy

Thomas Ria, MD

• Daprai, Laura, Laboratory of Microbiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy

Laura Daprai

• Gazzola, Alessandra, Experimental Zooprophylactic Institute of Lombardy and Emilia-Romagna, Lodi, Italy

Alessandra Gazzola, APN

• Bazzucchi, Alessandra, Laboratory of Microbiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy

Alessandra Bazzucchi

• Piccoli, Michela, Laboratory of Microbiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy

Michela Piccoli

• Possenti, Ilaria, Pediatric Unit, Pediatric Hospital C. Arrigo, Alessandria, Italy

Ilaria Possenti, MD

• Monzani, Alice, Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy

Alice Monzani, MD, PhD

• Martelli, Laura, Pediatric Unit, ASST Papa Giovanni XXIII, Bergamo, Italy

Laura Martelli, MD

• Amoroso, Angela, Pediatric Unit, ASST Papa Giovanni XXIII, Bergamo, Italy

Angela Amoroso, MD

• Pieri, Giovanni Raimondo, Pediatric Unit, Pediatric Hospital C. Arrigo, Alessandria, Italy

Giovanni Raimondo Pieri

• Vergori, Antonio, Pediatric Unit, Ospedale F. Del Ponte, Varese, Italy

Antonio Vergori, MD

• Monticone, Sonia, Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy

Sonia Monticone, MD

• Cerutti, Marta, Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy

Marta Cerutti

• Partenope, Cristina, Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy

Cristina Partenope, MD

• Bussolini, Anna Elisabetta, Pediatric Unit, ASST Settelaghi, Tradate, Italy

Anna Elisabetta Bussolini, MD

• Ferrari, Alessandra Chiara Francesca, Pediatric Unit, ASST Cremona, Cremona, Italy

Alessandra Chiara Francesca Ferrari, DrMed

• La Barba, Elisa, Pediatric Unit, ASST Lariana, Cantù, Italy

Elisa La Barba, PhD

• Smylie, Giulia Marie, Pediatric Unit, Ospedale di Busto Arsizio, ASST Valle Olona, Busto Arsizio, Italy

Giulia Marie Smylie, MD

• Benatti, Simone V, Clinic of Infectious Diseases, Dept of Health Sciences, University of Milan, ASST Santi Paolo e Carlo, Milan, Italy

Simone V Benatti, MD

• Luini, Mario Vittorio, Institute of Agricultural Biology and Biotechnology – IBBA-CNR, National Research Council, Lodi, Italy

Mario Vittorio Luini, DVM

Group or Team Name

• ItalKid-HUS Network.

Background

During the last decade, it has become increasingly common to diagnose Shiga Toxin Escherichia Coli-related (STEC) infection before Hemolytic Uremic Syndrome (HUS) has developed, providing a potential window of treatment opportunity that, besides generous rehydration, goes underexploited. Antibiotic treatment is historically contraindicated in Shiga Toxin-positive diarrhea on the assumption that it may trigger STEC-HUS. However, this concept is based on weak evidence mostly concerning bactericidal agents and may not apply to bacteriostatic antibiotics. Several in vitro and in vivo studies both on animal models and on humans indicate that azithromycin may be safe and effective in preventing HUS or mitigating disease severity.

Methods

All STEC infections were treated with azithromycin 10 mg/kg/die orally until diarrhea remission (maximum of 5 days).

Results

Twenty-seven patients (median age 4.4 years) with STEC-positive diarrhea were treated with azithromycin. The treatment was started after a median time of 4 days since the onset of symptoms (2 days since the onset of bloody diarrhea) and it was continued for a median time of 5 days. Of the treated patients, 19% were positive for Stx1, 44% for Stx2, 37% for both Stx1 and Stx2. One out of 27 patients developed HUS after the first dose of azithromycin. No treatment-related side effect was observed.

Conclusion

Azithromycin seems safe and may represent a useful therapeutic option in patients with STEC-positive diarrhea to prevent HUS. A controlled study is necessary but, in the meantime, STEC-infected patients should be treated based on the currently available evidence.