Impact of Antibiotics on the Intestinal Microbiota and on the Treatment of Shiga-toxin-Producing Escherichia coli and Salmonella Infections

This review evaluates the current literature based on the impact of antibiotics on the intestinal microbiota and the critical role of intestinal bacteria in controlling infection and subsequent clinical disease caused by STEC and Salmonella, and the transmissibility of these important pathogens. A number of studies have indicated that antibiotic therapy could result in unexpected changes in the clinical picture of disease. This is observed, for example, in the case of infections associated with Shiga-toxin-producing Escherichia coli (STEC), when antibiotics used in treatment of the disease may increase the risk of hemolytic uremic syndrome (HUS) and thus fatal outcomes. In the case of such infections, treatment with antibiotics is usually discouraged. The use of antibiotics could cause also undesirable changes in the intestinal microbial flora and prolonged pathogen shedding, which is observed in the case of Salmonella infections. Inappropriate antibiotic therapy can result in Salmonella remaining in the host's cells (intracellular) and thus resulting in further asymptomatic carriage and a further complication is the development of resistance.