Title: Antibiotics for pediatric bloody stools?
题目：小儿血便需要抗生素治疗吗？
Author 作者: Mimi Lu
翻译：葛赟 校对：肖锋

There are numerous different causes of pediatric hemorrhagic diarrhea. Consider a pediatric patient with bloody diarrhea as being at risk for developing hemolytic uremic syndrome.
小儿血性腹泻的病因很多。要警惕血便的患儿出现溶血性尿毒综合症。
Most cases of hemolytic uremic syndrome are caused by O157:H7 strains of E Coli that release Shiga-like toxin from the gut.
大部分溶血性尿毒综合症是由大肠埃希菌O157:H7菌株从肠道释放志贺样毒素引起。
Systemic release of the toxin causes microvascular thromboses in the renal microvasculature.
向全身释放毒素导致在肾微血管系统形成微血管血栓。
The characteristic microangiopathic hemolysis results with anemia, thrombocytopenia and peripheral schistocytes seen on laboratory studies, in addition to acute renal failure.
微血管内溶血的典型表现是贫血，血小板减少，外周血可找到裂红细胞，另外还会出现肾功能衰竭。
Antibiotics have been controversial in the treatment of pediatric hemorrhagic diarrhea due to concern that they worsen toxin release from children infected with E Coli O157:H7 and thus increase the risk of developing hemolytic uremic syndrome.
抗生素治疗小儿血性腹泻是有争议的，主要考虑到大肠埃希菌O157:H7菌株释放的毒素能增加发生溶血性尿毒综合症的风险。
Numerous previous studies have provided conflicting data regarding the true risk (1). A recent prospective study showed antibiotic treatment increases the risk (2). Most recommendations warn against using antibiotics to treat pediatric hemorrhagic diarrhea unless the patient is septic.
既往相当多的研究中存在着相互矛盾的观点（1）。最近的一个前瞻性研究显示，抗生素治疗能增加发生溶血性尿毒综合症的风险（2）。大部分建议都反对血性腹泻的患儿使用抗生素，除非出现脓毒症。
Bottom line: Avoid treating pediatric hemorrhagic diarrhea with antibiotics
要点：避免对血性腹泻患儿使用抗生素。

References 参考文献:
1. Systematic review: are antibiotics detrimental or beneficial for the treatment of patients with Escherichia coli O157:H7 infection? Alimentary Pharmacology & Therapeutics. Volume 24, Issue 5, pages 731–742, September 2006
2. Risk factors for the hemolytic uremic syndrome in children infected with Escherichia coli O157:H7: a multivariable analysis. Clin Infect Dis. 2012 Jul;55(1):33-41. doi: 10.1093/cid/cis299. Epub 2012 Mar 19.