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Volume 1, Number 4—October 1995

Dispatch

An Outbreak of Hemoytic Uremic Syndrome Associated with Antibiotic Treatment of Hospital Inpatients for Dysentery

Sami Al-Qarawi*, Robert E. Fontaine†, and Mohammed-Saeed Al-Qahtani*
Author affiliations: *Saudi Arabian Field Epidemiology Training Program, Ministry of Health, Saudi Arabia; †Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

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Table 2

Risk of developing hemolytic uremic syndrome (HUS) by antibiotic combinations used for in-hospital treatment of dysentery during a community outbreak of antibiotic-resistant Shigella dysenteriae type 1, Najran, Saudi Arabia, March through May 1993

Dysentery patients
95%
Antibiotic combination Developed HUS(10) Total (42) HUS rate/100 Risk ratio a confidence interval b
Ineffective c antibiotics without nalidixic acid d-j 6 12 50 4.3 1.3-15
Ampicillin combinations without nalidixic acid d-f 5 7 71 6.2 1.9-20
Ineffective antibiotics without nalidixic acid or ampicillin g-j 1 5 20 1.7 0.22-14
Ampicillin and nalidixic acid with (2) or without metronidazole (3) 1 3 33 2.9 0.40-20
Trimethoprim-sulfamethoxazole, nalidixic acid and metronidazole 0 1 0 0
Nalidixic acid with (24) or without (2) metronidazole (reference) 3 26 12 1.0 Reference

a Relative to the reference antibiotic combination (nalidixic acid with or without metronidazole).
b Taylor series approximation standard.
c Antibiotics to which the outbreak strain of S. dysenteriae type 1 was resistant (ampicillin, trimethoprim-sulfamethoxazole) or which are ineffective against shigella (metronidazole, gentamicin, or erythromycin).
d Ampicillin and metronidazole (4 patients). e Ampicillin, metronidazole, and gentamicin (2 patients).
f Ampicillin only (1 patient). g Trimethoprim-sulfamethoxazole and metronidazole (1 patient).
h Trimethoprim-sulfamethoxazole, erythromycin, and metronidazole (1 patient). i Metronidazole only (2 patients).
j Erythromycin and metronidazole (1 patient).

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