Escherichia coli enteritis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Yazan Daaboul, M.D.; Serge Korjian M.D.

Medical Therapy

Rehydration

• The mainstay of therapy for E. coli enteritis is rehydration.

• Oral rehydration fluids is indicated among patients who can tolerate oral intake, otherwise IV rehydration is indicated.
• Over the counter oral rehydration solutions (ORS) are optimal options for oral rehydration and are usually available for both adults and children.
• Oral rehydration solutions may be home-made by mixing the following:

• Drinking water: 1 liter
• Salt: 0.5 teaspoon
• Sugar: 6 teaspoons

• Rehydration must be gradual until signs of dehydration (e.g. dry mouth, oliguria) are resolved. Drinking ORS must be slow (1 sip every 5 minutes).
• Children often require 1 liter of ORS, whereas adults often require 3 liters of ORS.
• Energy drinks with high concentrations of electrolytes (e.g. sports drinks) may be offered to adults, but not children.
• Fluids high in sugar content (e.g. soda) are not recommended because they may worsen the dehydration.

Antimicrobial Therapy

• Since the majority of cases of E. coli enteritis are self-limited, 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 infections due to possibly increased risk of hemolytic uremic syndrome and prolonged shedding of the organism and production of Shiga-like toxins.

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 and prolonged shedding.