Stephen J.LurieMD, PhD, Senior Editor
To the Editor: We are concerned that Dr Safdar and colleagues1 did not account for important limitations of 2 of the studies in their meta-analysis. First, of the 300 culture-positive patients in the study by Ikeda et al,2 100% of patients who had HUS were given antibiotics (including, but not limited to, fosfomycin). Among those who did not develop HUS, 99% of patients received antibiotics. This analysis lacks a significant control group of culture-positive patients who did not receive antibiotics; Safdar et al stated this would be a criterion for exclusion. Furthermore, the OR that Safdar et al report is only for fosfomycin administered on day 2 of illness and not on other days. This is after excluding culture-positive treated patients with incomplete and complete HUS, and those treated with antibiotics other than fosfomycin. Thus, the OR showing a significant negative association may be a spurious finding.
Wong CS, Brandt JR. Risk of Hemolytic Uremic Syndrome From Antibiotic Treatment of Escherichia coli O157:H7 Colitis. JAMA. 2002;288(24):3111. doi:10.1001/jama.288.24.3111-JLT1225-2-2