Escherichia Coli Infections Medication

  • Author: Tarun Madappa, MD, MPH; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Nov 15, 2011
 

Medication Summary

E coli meningitis requires antibiotics, such as third-generation cephalosporins (eg, ceftriaxone).

E coli pneumonia requires respiratory support, adequate oxygenation, and antibiotics, such as third-generation cephalosporins or fluoroquinolones.

E coli cholecystitis/cholangitis requires antibiotics such as third-generation cephalosporins that cover E coli and Klebsiella organisms. Empiric coverage should also include anti– E faecalis coverage.

For E coli intra-abdominal abscess, antibiotics also must include anaerobic coverage (eg, ampicillin and sulbactam or cefoxitin). In severe infection, piperacillin and tazobactam, imipenem and cilastatin, or meropenem may be used. Combination therapy with antibiotics that cover E coli plus an antianaerobe can also be used (eg, levofloxacin plus clindamycin or metronidazole).

E coli enteric infections require fluid replacement with solutions containing appropriate electrolytes. Antimicrobials known to be useful in cases of traveler's diarrhea include doxycycline, trimethoprim/sulfamethoxazole (TMP/SMZ), fluoroquinolones, and rifaximin. They shorten the duration of diarrhea by 24-36 h. Antibiotics are not useful in enterohemorrhagic E coli (EHEC) infection and may predispose to development of HUS. Antimotility agents are contraindicated in children and in persons with enteroinvasive E coli (EIEC) infection.

Uncomplicated E coli cystitis can be treated with a single dose of antibiotic or 3-d course of a fluoroquinolone, TMP/SMZ, or nitrofurantoin.

Recurrent E coli cystitis (ie, >2 episodes/y) is treated with continuous or postcoital prophylaxis with a fluoroquinolone, TMP/SMZ, or nitrofurantoin.

Patients with complex cases (eg, those with diabetes, >65 y, or recent history of UTI) are treated with a 7- to 14-d course of antibiotics (eg, levofloxacin, third-generation cephalosporins, or aztreonam).

Acute uncomplicated E coli pyelonephritis in young women is treated with fluoroquinolone or TMP/SMZ for 14 d. Patients with vomiting, nausea, or underlying illness (eg, diabetes) should be admitted to the hospital. If fever and flank pain persist for more than 72 h, ultrasonography or CT scanning may be performed.

Treat E coli perinephric abscess or prostatitis with at least 6 wk of antibiotics.

E coli sepsis requires at least 2 wk of antibiotics and identification of the source of bacteremia based on imaging study results.

McGannon et al found that antibiotics that target DNA synthesis, such as ciprofloxacin (CIP) and TMP/SMZ, showed increased Shiga toxin production, whereas antibiotics that target the cell wall, transcription, or translation did not.[6] Remarkably, high levels of Shiga toxin were detected even when growth of O157:H7 was completely suppressed by CIP. In contrast, azithromycin significantly reduced Shiga toxin levels even when O157:H7 viability remained high.

Next

Antibiotics

Class Summary

Empiric antimicrobial therapy must be comprehensive and cover all likely pathogens in the context of this clinical setting.

View full drug information

Doxycycline (Vibramycin)

 

Inhibits protein synthesis and thus, bacterial growth, by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. Used to treat traveler's diarrhea.

View full drug information

Trimethoprim/sulfamethoxazole (Bactrim DS, Septra)

 

Inhibits bacterial growth by inhibiting synthesis of dihydrofolic acid. Used to treat traveler's diarrhea for 5 d, uncomplicated UTI for 3 d, complicated UTI for 10-14 d, and acute prostatitis for 6-12 wk.

View full drug information

Ciprofloxacin (Cipro)

 

Fluoroquinolone that inhibits bacterial DNA synthesis and, consequently, growth. Used to treat mild-to-moderate UTI for 7-14 d, acute uncomplicated cystitis for 3 d, severe-to-complicated UTI for 7-14 d, infectious diarrhea for 5-7 d, and chronic bacterial prostatitis for 4-6 wk.

View full drug information

Levofloxacin (Levaquin)

 

For infections due to multidrug-resistant gram-negative organisms. Used to treat community-acquired pneumonia for 7-14 d, acute pyelonephritis and complicated UTI for 10 d, and traveler's diarrhea for 5 d.

View full drug information

Amoxicillin (Amoxil, Trimox)

 

Interferes with synthesis of cell wall mucopeptides during active multiplication, resulting in bactericidal activity against susceptible bacteria. Used to treat uncomplicated UTI for 7 d and complicated UTI or pyelonephritis for 10-14 d.

View full drug information

Aztreonam (Azactam)

 

Monobactam that inhibits cell wall synthesis during bacterial growth. Active against aerobic gram-negative bacilli. Used to treat complicated UTIs/pyelonephritis and bacteremia for 7-14 d, intra-abdominal infections for 14-21 d, and pneumonia for 14 d.

View full drug information

Ampicillin and sulbactam (Unasyn)

 

Drug combination of beta-lactamase inhibitor with ampicillin. Used to treat intra-abdominal infections for 14-21 d.

View full drug information

Nitrofurantoin (Macrodantin)

 

Synthetic nitrofuran that interferes with bacterial carbohydrate metabolism by inhibiting acetylcoenzyme A. Used to treat uncomplicated UTIs for 7 d or for 3 d after urine is sterile.

View full drug information

Meropenem (Merrem IV)

 

Bactericidal broad-spectrum carbapenem antibiotic that inhibits cell wall synthesis. Effective against most gram-positive and gram-negative bacteria. Used to treat intra-abdominal infections for 14-21 d.

View full drug information

Ceftriaxone (Rocephin)

 

Third-generation cephalosporin that arrests bacterial growth by binding to one or more penicillin-binding proteins. Used to treat meningitis and bacteremia for 14-21 d and pneumonia, complicated UTI, or pyelonephritis for 14 d.

View full drug information

Piperacillin and tazobactam (Zosyn)

 

Antipseudomonal penicillin plus beta-lactamase inhibitor. Inhibits biosynthesis of cell wall mucopeptide and is effective during stage of active multiplication. Used to treat intra-abdominal infections for 14-21 d.

View full drug information

Imipenem and cilastatin (Primaxin)

 

For treatment of multiple-organism infections in which other agents do not have wide-spectrum coverage or are contraindicated due to potential for toxicity. Used to treat pneumonia and complicated UTI for 14 d, bacteremia for 7 d, and intra-abdominal abscess for 14-21 d.

View full drug information

Rifaximin (Xifaxan, RedActiv, Flonorm)

 

Nonabsorbed (< 0.4%), broad-spectrum antibiotic specific for enteric pathogens of the gastrointestinal tract (ie, gram-positive, gram-negative, aerobic, anaerobic). Rifampin structural analog. Binds to beta-subunit of bacterial DNA-dependent RNA polymerase, thereby inhibiting RNA synthesis. Indicated for E coli (enterotoxigenic and enteroaggregative strains) associated with travelers' diarrhea.

Previous
Proceed to Follow-up
 
 
Contributor Information and Disclosures
Author

Tarun Madappa, MD, MPH  Attending Physician, Department of Pulmonary and Critical Care Medicine, Elkhart General Hospital

Tarun Madappa, MD, MPH is a member of the following medical societies: American College of Chest Physicians and American Thoracic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Chi Hiong U Go, MD  Assistant Professor, Department of Internal Medicine, Texas Tech University Health Science Center at Odessa

Chi Hiong U Go, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Larry I Lutwick, MD  Professor of Medicine, State University of New York Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Charles V Sanders, MD  Edgar Hull Professor and Chairman, Department of Internal Medicine, Professor of Microbiology, Immunology and Parasitology, Louisiana State University School of Medicine at New Orleans; Medical Director, Medicine Hospital Center, Charity Hospital and Medical Center of Louisiana at New Orleans; Consulting Staff, Ochsner Medical Center

Charles V Sanders, MD is a member of the following medical societies: Alliance for the Prudent Use of Antibiotics, Alpha Omega Alpha, American Association for the Advancement of Science, American Association of University Professors, American Clinical and Climatological Association, American College of Physician Executives, American College of Physicians, American Federation for Medical Research, American Foundation for AIDS Research, American Geriatrics Society, American Lung Association, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Association for Professionals in Infection Control and Epidemiology, Association of American Medical Colleges, Association of American Physicians, Association of Professors of Medicine, Infectious Disease Society for Obstetrics and Gynecology, Infectious Diseases Society of America, Louisiana State Medical Society, Orleans Parish Medical Society, Royal Society of Medicine, Sigma Xi, Society of General Internal Medicine, Southeastern Clinical Club, Southern Medical Association, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology

Disclosure: Baxter International and Johnson & Johnson Royalty Other

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Eleftherios Mylonakis, MD, to the development and writing of this article.

References

  1. Kappeli U, Hachler H, Giezendanner N, Beutin L, Stephan R. Human Infections with Non-O157 Shiga Toxin-producing Escherichia coli, Switzerland, 2000-2009. Emerg Infect Dis. Feb 2011;17(2):180-5. [Medline].

  2. Frank C, Werber D, Cramer JP, Askar M, Faber M, an der Heiden M, et al. Epidemic profile of Shiga-toxin-producing Escherichia coli O104:H4 outbreak in Germany. N Engl J Med. Nov 10 2011;365(19):1771-80. [Medline].

  3. Buchholz U, Bernard H, Werber D, Böhmer MM, Remschmidt C, Wilking H, et al. German outbreak of Escherichia coli O104:H4 associated with sprouts. N Engl J Med. Nov 10 2011;365(19):1763-70. [Medline].

  4. Camins BC, Marschall J, De Vader SR, Maker DE, Hoffman MW, Fraser VJ. The clinical impact of fluoroquinolone resistance in patients with E coli bacteremia. J Hosp Med. Jul 2011;6(6):344-9. [Medline]. [Full Text].

  5. Walmsley RS, David DB, Allan RN, Kirkby GR. Bilateral endogenous Escherichia coli endophthalmitis: a devastating complication in an insulin-dependent diabetic. Postgrad Med J. Jun 1996;72(848):361-3. [Medline].

  6. McGannon CM, Fuller CA, Weiss AA. Different classes of antibiotics differentially influence shiga toxin production. Antimicrob Agents Chemother. Sep 2010;54(9):3790-8. [Medline].

  7. Pitout JD, Laupland KB. Extended-spectrum beta-lactamase-producing Enterobacteriaceae: an emerging public-health concern. Lancet Infect Dis. Mar 2008;8(3):159-66. [Medline].

  8. Melzer M, Petersen I. Mortality following bacteraemic infection caused by extended spectrum beta-lactamase (ESBL) producing E. coli compared to non-ESBL producing E. coli. J Infect. Sep 2007;55(3):254-9. [Medline].

  9. Agustin ET, Gill V, Domenico P. CSF gram stain in meningitis. Intern Med. 1994;15:14-24.

  10. Barnett BJ, Stephens DS. Urinary tract infection: an overview. Am J Med Sci. Oct 1997;314(4):245-9. [Medline].

  11. Boam WD, Miser WF. Acute focal bacterial pyelonephritis. Am Fam Physician. Sep 1 1995;52(3):919-24. [Medline].

  12. Bohnen JM. Antibiotic therapy for abdominal infection. World J Surg. Feb 1998;22(2):152-7. [Medline].

  13. Bonoan JT, Mehra S, Cunha BA. Emphysematous pyelonephritis. Heart Lung. Nov-Dec 1997;26(6):501-3. [Medline].

  14. Carpenter HA. Bacterial and parasitic cholangitis. Mayo Clin Proc. May 1998;73(5):473-8. [Medline].

  15. Childs SJ. Current concepts in the treatment of urinary tract infections and prostatitis. Am J Med. Dec 30 1991;91(6A):120S-123S. [Medline].

  16. Cunha BA. Abdominal pain in patients with diabetis mellitus. Infect Dis Prac. 1997;21:14-5.

  17. Cunha BA. Acute acalculous cholecystitis. Infect Dis Prac. 1997;21:70-1.

  18. Cunha BA. Acute and chronic bacterial prostatitis. Infect Dis Prac. 1994;18:78-9.

  19. Cunha BA. Antibiotic concentration dependent susceptibility of urinary tract isolates. Antib Clinician. 1999;3:57-8.

  20. Cunha BA. Quinolones: Clinical aspects. Antib Clinician. 1998;2:129-35.

  21. Cunha BA. The fluoroquinolones for urinary tract infections: a review. Adv Ther. Nov-Dec 1994;11(6):277-96. [Medline].

  22. Cunha BA. Therapeutic approach in treating UTIs. Antib Clinician. 1998;2(S2):35-40.

  23. Cunha BA. Urine gram stain in urosepsis. Intern Med. 1997;18:75-8.

  24. Cunha BA. Urosepsis. J Crit Ill. 1997;12:616-25.

  25. Donnenberg MS, Kaper JB. Enteropathogenic Escherichia coli. Infect Immun. Oct 1992;60(10):3953-61. [Medline].

  26. DuPont HL. Travellers' diarrhoea: contemporary approaches to therapy and prevention. Drugs. 2006;66(3):303-14. [Medline].

  27. Eisenstein BI, Jones GW. The spectrum of infections and pathogenic mechanisms of Escherichia coli. Adv Intern Med. 1988;33:231-52. [Medline].

  28. Glandt M, Adachi JA, Mathewson JJ, Jiang ZD, DiCesare D, Ashley D. Enteroaggregative Escherichia coli as a cause of traveler's diarrhea: clinical response to ciprofloxacin. Clin Infect Dis. Aug 1999;29(2):335-8. [Medline].

  29. Gold R. Bacterial meningitis--1982. Am J Med. Jul 28 1983;75(1B):98-101. [Medline].

  30. Hansing CE, Allen VD, Cherry JD. Escherichia coli endocarditis. A review of the literature and a case study. Arch Intern Med. Oct 1967;120(4):472-7. [Medline].

  31. Harrington SM, Dudley EG, Nataro JP. Pathogenesis of enteroaggregative Escherichia coli infection. FEMS Microbiol Lett. Jan 2006;254(1):12-8. [Medline].

  32. Harvey D, Holt DE, Bedford H. Bacterial meningitis in the newborn: a prospective study of mortality and morbidity. Semin Perinatol. Jun 1999;23(3):218-25. [Medline].

  33. Johnson JR. Virulence factors in Escherichia coli urinary tract infection. Clin Microbiol Rev. Jan 1991;4(1):80-128. [Medline].

  34. Jonas M, Cunha BA. Bacteremic Escherichia coli pneumonia. Arch Intern Med. Nov 1982;142(12):2157-9. [Medline].

  35. Klein NC, Cunha BA. Third-generation cephalosporins. Med Clin North Am. Jul 1995;79(4):705-19. [Medline].

  36. Koutkia P, Mylonakis E, Flanigan T. Enterohemorrhagic Escherichia coli O157:H7--an emerging pathogen. Am Fam Physician. Sep 1 1997;56(3):853-6, 859-61. [Medline].

  37. Lepelletier D, Caroff N, Reynaud A, Richet H. Escherichia coli: epidemiology and analysis of risk factors for infections caused by resistant strains. Clin Infect Dis. Sep 1999;29(3):548-52. [Medline].

  38. Lerner AM. The gram-negative bacillary pneumonias. Dis Mon. Nov 1980;27(2):1-56. [Medline].

  39. McDonald MI. Pyogenic liver abscess: diagnosis, bacteriology and treatment. Eur J Clin Microbiol. Dec 1984;3(6):506-9. [Medline].

  40. Mead PS, Griffin PM. Escherichia coli O157:H7. Lancet. Oct 10 1998;352(9135):1207-12. [Medline].

  41. Moon HW. Pathogenesis of enteric diseases caused by Escherichia coli. Adv Vet Sci Comp Med. 1974;18(0):179-211. [Medline].

  42. Neu HC. Infections due to gram-negative bacteria: an overview. Rev Infect Dis. Nov-Dec 1985;7 Suppl 4:S778-82. [Medline].

  43. Nordmann P. Trends in beta-lactam resistance among Enterobacteriaceae. Clin Infect Dis. Aug 1998;27 Suppl 1:S100-6. [Medline].

  44. Ortega AM, Cunha BA. Acute prostatitis. Contemp Urol. 1997;18:73-80.

  45. Palmer DL. Microbiology of pneumonia in the patient at risk. Am J Med. May 15 1984;76(5A):53-60. [Medline].

  46. Phillips AD, Frankel G. Mechanisms of gut damage by Escherichia coli. Baillieres Clin Gastroenterol. Sep 1997;11(3):465-83. [Medline].

  47. Roberts JA. Pyelonephritis, cortical abscess, and perinephric abscess. Urol Clin North Am. Nov 1986;13(4):637-45. [Medline].

  48. Savatta D, Cunha BA. Acute pyelonephritis and its mimics: Xanthogranulomaotus pyelonephritis and malacoplakia. Infect Dis Prac. 1996;20:86-8.

  49. Schimpff SC. Gram-negative bacteremia. Support Care Cancer. Jan 1993;1(1):5-18. [Medline].

  50. Schindzielorz A, Edberg SC, Bia FJ. Strongyloides stercoralis hyperinfection and central nervous system involvement in a patient with relapsing polychondritis. South Med J. Aug 1991;84(8):1055-7. [Medline].

  51. Shea KW, Cunha BA. Escherichia coli sternal osteomyelitis after open heart surgery. Heart Lung. Mar-Apr 1995;24(2):177-8. [Medline].

  52. Tabacof J, Feher O, Katz A, et al. Strongyloides hyperinfection in two patients with lymphoma, purulent meningitis, and sepsis. Cancer. Oct 15 1991;68(8):1821-3. [Medline].

  53. Tan JS, File TM. Urinary tract infections in obstetrics and gynecology. J Reprod Med. Mar 1990;35(3 Suppl):339-42. [Medline].

  54. Tenner SM, Yadven MW, Kimmel PL. Acute pyelonephritis. Preventing complications through prompt diagnosis and proper therapy. Postgrad Med. Feb 1 1992;91(2):261-8. [Medline].

  55. Tice AD. Short-course therapy of acute cystitis: a brief review of therapeutic strategies. J Antimicrob Chemother. Mar 1999;43 Suppl A:85-93. [Medline].

  56. Wanke CA. Escherichia coli. J Diarrhoeal Dis Res. Mar 1988;6(1):1-5. [Medline].

  57. Weinberger M, Cytron S, Servadio C, et al. Prostatic abscess in the antibiotic era. Rev Infect Dis. Mar-Apr 1988;10(2):239-49. [Medline].

  58. Westphal JF, Brogard JM. Biliary tract infections: a guide to drug treatment. Drugs. Jan 1999;57(1):81-91. [Medline].

  59. Whipp SC, Rasmussen MA, Cray WC Jr. Animals as a source of Escherichia coli pathogenic for human beings. J Am Vet Med Assoc. Apr 15 1994;204(8):1168-75. [Medline].

 
Previous
Next
 
Escherichia coli liver abscess.
Escherichia coli right pyelonephritis.
Escherichia coli on Gram stain. Gram-negative bacilli.
Escherichia coli culture on MacConkey agar.
Table. Differential Diagnoses of E coli Infection
OrganismInd*UreaseMotilityGlu Ferm†Lact Ferm‡Sucr Ferm§Malt Ferm||Esc Hyd¶Hyd Sulf TSI#OxidaseOrn Dec**Lys Dec††
E coli+-++++/-+---+/-+
Klebsiella pneumoniae-+/--+++++---+
P mirabilis-+++----+-+-
Proteus vulgaris++++-+++/-+---
Pseudomonas aeruginosa-+/-++



(ox)‡‡



-----+--
Enterobacter aerogenes--++++++--++
Enterobacter cloacae--+++++---+-
Salmonella typhi--++--+-+--+
Citrobacter freundii+/--+++++-+/----
Serratia marcescens-+/-++-+++--++
*Indole



†Glucose fermentation



‡Lactose fermentation



§Sucrose fermentation



||Maltose fermentation



¶Esculin hydrolysis



#Hydrogen sulfite on TSI



**Ornithine decarboxylase



††Lysine decarboxylase



‡‡Oxidative



Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.