View source for Escherichia coli enteritis medical therapy

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{{Escherichia coli enteritis}}
{{CMG}} {{AE}} {{YD}}; {{SSK}}
==Overview==
[[Rehydration]] is the mainstay of [[therapy]] of [[Escherichia coli enteritis|''E. coli'' enteritis]]. [[Mouth|Oral]] [[rehydration]] [[Fluid|fluids]] (e.g. [[Mouth|oral]] [[rehydration]] [[Solution|solutions]]) are indicated among [[Patient|patients]] who can tolerate [[Mouth|oral]] intake, otherwise [[Intravenous therapy|IV]] [[rehydration]] is indicated. Since the majority of cases of [[Escherichia coli enteritis|''E. coli'' enteritis]] are self-limited and the exact [[Infection|infective]] [[Strain (biology)|strain]] is often not identified, [[Empiric therapy|empiric]] [[antimicrobial]] [[therapy]] is generally not recommended. [[Antimicrobial]] [[therapy]] using either [[fluoroquinolone]] or [[TMP-SMX]] may be administered (but is not required) in [[ETEC]] [[infection]] ([[traveler's diarrhea]]), [[EPEC]] [[infection]], and [[EIEC]] [[infection]], but not in [[EHEC]] [[infection]] (due to increased risk of [[hemolytic uremic syndrome]] and prolonged shedding). In adults, additional [[Pharmacology|pharmacologic]] [[Therapy|therapies]] may include [[Antiemetic|antiemetic agents]] (not recommended in [[Pediatrics|pediatric]] [[Patient|patients]]). [[Antidiarrheal|Antidiarrheal agents]] are generally not recommended during the [[Acute (medicine)|acute]] [[infection]] phase.

==Medical Therapy==
===Rehydration===
*The mainstay of [[therapy]] for [[Escherichia coli enteritis|''E. coli'' enteritis]] is [[rehydration]].
:*[[Mouth|Oral]] [[rehydration]] fluids are indicated among [[Patient|patients]] who can tolerate [[Mouth|oral]] intake, otherwise [[Intravenous therapy|IV]] [[rehydration]] is indicated.
:*Over the counter [[Mouth|oral]] [[rehydration]] [[Solution|solutions]] (ORS) are optimal options for [[Mouth|oral]] [[rehydration]] and are usually available for both [[Adult|adults]] and [[Child|children]].
:*[[Mouth|Oral]] [[rehydration]] [[Solution|solutions]] may be home-made by mixing the following:
::*Drinking [[water]]: 1 liter
::*[[Salt]]: 0.5 [[teaspoon]]
::*[[Sugar]]: 6 [[Teaspoon|teaspoons]]
:*[[Rehydration]] must be gradual until [[Medical sign|signs]] of [[dehydration]] (e.g. [[Dry-mouth|dry mouth]], [[oliguria]]) are resolved.  Drinking ORS must be slow (1 sip every 5 minutes).
:*[[Child|Children]] often require 1 liter of ORS, whereas [[Adult|adults]] often require 3 liters of ORS. 
:*[[Energy]] drinks with high concentrations of [[Electrolyte|electrolytes]] (e.g. [[Sports drink|sports drinks]]) may be offered to [[Adult|adults]], but not [[Child|children]].
:*[[Fluid|Fluids]] high in [[sugar]] content (e.g. soda) are not recommended because they may worsen the [[dehydration]].
[[Image:CDC ORS.png|900px]]
===Antimicrobial Therapy===
*Since the majority of cases of [[Escherichia coli enteritis|''E. coli'' enteritis]] are self-limited and the exact [[Infection|infective]] [[Strain (biology)|strain]] is often not identified, [[Empiric therapy|empiric]] [[antimicrobial]] [[therapy]] is generally not recommended.
*[[Antimicrobial]] [[therapy]] using either [[TMP-SMX]] or [[fluoroquinolone]] may be administered (but is not required) in [[ETEC]] [[infection]] ([[traveler's diarrhea]]), [[EPEC]] [[infection]], and [[EIEC]] [[infection]].
*In contrast, [[antimicrobial]] [[therapy]] is NOT recommended in [[EHEC]] ([[STEC]] or VTEC) [[Infection|infections]] due to possibly increased risk of [[hemolytic uremic syndrome]] and prolonged shedding of the [[organism]] and production of [[Enterotoxin|enterotoxins]].

===Other Pharmacologic Agents===
::*'''1. Escherichia coli species'''
:::*'''1.1. Enterotoxigenic ''E. coli'' (ETEC)'''
::::*Preferred regimen: [[TMP-SMX]], 160 and 800 mg, respectively, bid, for 3-7 days (if susceptible) {{or}} [[Fluoroquinolone]] (e.g., 300 mg [[Ofloxacin]], 400 mg [[Norfloxacin]], or 500 mg [[Ciprofloxacin]] bid for 3-7 days)

:::*'''1.2. Enteropathogenic ''E. coli'' (EPEC)'''
::::*Preferred regimen: [[TMP-SMX]], 160 and 800 mg, respectively, bid, for 3-7 days (if susceptible) {{or}} [[Fluoroquinolone]] (e.g., 300 mg [[Ofloxacin]], 400 mg [[Norfloxacin]], or 500 mg [[Ciprofloxacin]] bid for 3-7 days)

:::*'''1.3. Enteroinvasive ''E. coli'' (EIEC) '''
::::*Preferred regimen: [[TMP-SMX]], 160 and 800 mg, respectively, bid, for 3-7 days (if susceptible) {{or}} [[Fluoroquinolone]] (e.g., 300 mg [[Ofloxacin]], 400 mg [[Norfloxacin]], or 500 mg [[Ciprofloxacin]] bid for 3-7 days)

:::*'''1.4. Enterohemorrhagic ''E. coli'' (EHEC)'''
::::*Preferred regimen: [[Antibiotic]] therapy is not recommended due to possibly increased risk of [[Hemolytic-uremic syndrome|hemolytic uremic syndrome]] and prolonged shedding.

==References==
{{Reflist|2}}

[[Category:Disease]]
[[Category:Gastroenterology]]
[[Category:Foodborne illnesses]]
[[Category:Emergency medicine]]
[[Category:Bacterial diseases]]