eMedicine Specialties > Infectious Diseases > Bacterial Infections
Escherichia Coli Infections: Treatment & Medication
Updated: Feb 19, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
- Medical care of E coli infection is based on the site and severity of infection.
- In addition to antibiotics, provide supportive care, such as hydration, adequate oxygenation, and blood pressure support, if indicated.
Surgical Care
- E coli cholecystitis/cholangitis - Surgical drainage/decompression
- E coli intra-abdominal abscess - Surgical debridement
- E coli urinary tract infection
- In obstruction, such as prostatic hypertrophy, TURP may be indicated.
- In some cases, place ureteral stents for obstructed renal stones; however, remove these stents as soon as possible.
- Institute adequate surgical drainage for prostatic abscesses using transurethral unroofing or a perineal incision.
Diet
- Food should be given to prevent malnutrition during an E coli diarrheal episode.
Activity
- Activity can be continued as tolerated by the patient.
Medication
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.
Antibiotics
Empiric antimicrobial therapy must be comprehensive and cover all likely pathogens in the context of this clinical setting.
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.
Adult
100 mg PO q12h for 5 d
Pediatric
<8 years: Not recommended, can cause permanent discoloration of teeth
>8 years and <100 lb: 2 mg/lb PO divided bid on day 1, then 1 mg/lb PO qd or divided bid
>8 years and >100 lb: Administer as in adults
Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; can increase hypoprothrombinemic effects of anticoagulants; can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy
Documented hypersensitivity; severe hepatic dysfunction
Pregnancy
D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus
Precautions
Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last half of pregnancy through 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines
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.
Adult
160 mg TMP/800 mg SMZ PO/IV q12h
Pediatric
<2 months: Do not administer
>2 months: 8 mg/kg/d TMP/40 mg/kg/d SMZ PO q12h for 10 d
May increase PT when used with warfarin (perform coagulation tests and adjust dose accordingly); coadministration with dapsone may increase blood levels of both drugs; coadministration of diuretics increases incidence of thrombocytopenia purpura in elderly persons; phenytoin levels may increase with coadministration; may potentiate effects of methotrexate in bone marrow depression; hypoglycemic response to sulfonylureas may increase with coadministration; may increase levels of zidovudine
Documented hypersensitivity; megaloblastic anemia due to folate deficiency
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Obtain CBC counts frequently; discontinue therapy if significant hematologic changes occur; goiter, diuresis, and hypoglycemia may occur with sulfonamides; prolonged IV infusions or high doses may cause bone marrow depression (if signs occur, administer 5-15 mg/d leucovorin); caution in folate deficiency (eg, chronic alcoholism, elderly, anticonvulsant therapy, malabsorption syndrome); hemolysis may occur in G-6-PD deficiency, patients with AIDS may not tolerate or respond to TMP/SMZ; caution in renal or hepatic impairment (perform urinalyses and renal function tests during therapy); administer fluids to prevent crystalluria and stone formation; avoid in pregnancy at term and breastfeeding because sulfonamides may cause kernicterus in infants; discontinue at first appearance of skin rash or sign of adverse reaction (eg, Stevens-Johnson syndrome, toxic epidermal necrolysis, agranulocytosis)
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.
Adult
500 mg PO bid; alternatively, 400 mg IV q12h
Pediatric
<6 years: Not established
>6 years: Administer as in adults
Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2-4 h before or after taking fluoroquinolones; cimetidine may interfere with metabolism; reduces therapeutic effects of phenytoin; probenecid may increase serum concentrations; may increase toxicity of theophylline, caffeine, cyclosporine, and digoxin (monitor digoxin levels); may increase effects of anticoagulants (monitor PT); leads to hypoglycemia in patients concurrently receiving glyburide
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
In prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); adjust dose in renal function impairment; superinfections may occur with prolonged or repeated antibiotic therapy; avoid alkalinizing urine (crystalluria has been reported); caution in seizure disorder; photosensitivity may occur with prolonged exposure to sunlight or tanning equipment
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.
Adult
500 mg PO/IV qd
Pediatric
<6 years: Not recommended
>6 years: Not established
Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2-4 h before or after taking fluoroquinolones; cimetidine may interfere with metabolism; reduces therapeutic effects of phenytoin; probenecid may increase serum concentrations; may increase toxicity of theophylline, caffeine, cyclosporine, and digoxin (monitor digoxin levels); may increase effects of anticoagulants (monitor PT)
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
In prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); adjust dose in renal function impairment; superinfections may occur with prolonged or repeated antibiotic therapy
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.
Adult
500 mg PO q8h; not to exceed 3 g/d
Pediatric
<20 kg: 40 mg/kg/d PO divided q8h
>20 kg: Administer as in adults
Reduces efficacy of oral contraceptives
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in renal impairment
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.
Adult
1-2 g IV q8h
Pediatric
30 mg/kg IV q8h
Tetracyclines may reduce effects
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in renal insufficiency; caution in hepatic impairment
Ampicillin and sulbactam (Unasyn)
Drug combination of beta-lactamase inhibitor with ampicillin. Used to treat intra-abdominal infections for 14-21 d.
Adult
1.5 (1 g ampicillin + 0.5 g sulbactam) to 3 g (2 g ampicillin + 1 g sulbactam) IV q6h; not to exceed 4 g/d sulbactam or 8 g/d ampicillin
Pediatric
Not established
Probenecid and disulfiram elevate ampicillin levels; allopurinol decreases ampicillin effects and has additive effects on ampicillin rash; may decrease effects of oral contraceptives
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in renal failure; evaluate rash and differentiate from hypersensitivity reaction
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.
Adult
100 mg PO q12h
Pediatric
<1 month: Not recommended
>1 month: 5-7 mg/kg/d PO divided qid
Anticholinergics may delay gastric emptying and increase absorption, increasing bioavailability; antacids made of magnesium salts may decrease effects by decreasing absorption; high doses of concurrent probenecid decrease renal clearance and increase toxicity of nitrofurantoin
Documented hypersensitivity; renal insufficiency (CrCl <60 mL/min), anuria, oliguria; do not use for pyelonephritis or perinephric abscess
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
May cause severe and irreversible peripheral neuropathy that can be fatal; renal impairment, diabetes, electrolyte imbalance, anemia, and vitamin B deficiency increase risk for adverse effects; prolonged use of antibiotics may result in fungal or bacterial overgrowth of resistant or nonsusceptible organisms; take with food to enhance tolerance and improve absorption; interstitial pneumonitis or pulmonary fibrosis, optic neuritis, and hemolytic anemia may occur
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.
Adult
1 g IV q8h
Pediatric
<3 months: Not recommended
>3 months: 20 mg/kg IV q8h
Probenecid may inhibit renal excretion, increasing meropenem levels
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Pseudomembranous colitis and thrombocytopenia may occur, requiring immediate discontinuation of medication
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.
Adult
2 g IV divided bid; not to exceed 4 g/d
Pediatric
Neonatal meningitis: 50-75 mg/kg/d IV divided q12h
Probenecid may increase levels; coadministration with ethacrynic acid, furosemide, and aminoglycosides may increase nephrotoxicity
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Adjust dose in severe renal insufficiency (high doses may cause CNS toxicity); superinfections, pseudobiliary lithiasis, non– C difficile diarrhea, and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy; caution in breastfeeding
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.
Adult
4.5 g IV q8h
Pediatric
<12 years: Not established
>12 years: Administer as in adults
Tetracyclines may decrease effects of piperacillin; high concentrations of piperacillin may physically inactivate aminoglycosides if administered in same IV line; effects are synergistic when administered concurrently with aminoglycosides; probenecid may increase penicillin levels; prolongs neuromuscular blockade of vecuronium if used concomitantly; if used with heparin, monitor coagulation parameters frequently
Documented hypersensitivity
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
Perform CBC counts prior to initiation of therapy and at least weekly during therapy; monitor for liver function abnormalities by measuring AST and ALT during therapy; caution in hepatic disease; perform urinalysis and BUN and creatinine determinations during therapy and adjust dose if values become elevated; monitor blood levels to avoid possible neurotoxic reactions
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.
Adult
500 mg IV q6h
Pediatric
<12 years: Not established
>12 years: Administer as in adults
Coadministration with cyclosporine may increase adverse CNS effects of both agents; coadministration with ganciclovir may result in generalized seizures
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Adjust dose in renal insufficiency; caution in CNS disorders (eg, brain lesions, history of seizures); for hemodialysis, use only when benefit outweighs risk of seizures
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.
Adult
200 mg PO tid
Pediatric
<12 years: Not established
>12 years: Administer as in adults
Induces CYP450 3A4 in vitro; limited data exist; no significant interactions shown in single-dose studies with midazolam and oral contraceptives
Documented hypersensitivity to rifaximin or rifamycin antimicrobial agents (eg, rifampin)
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
May promote intestinal bacterial overgrowth and cause superinfection; discontinue if diarrhea persists >24-48 h or worsens; seek immediate medical care if fever and/or bloody stools emerge (tablets not effective); not effective for travelers' diarrhea due to suspected pathogens other than E coli; postmarketing reports include allergic dermatitis, rash, angioneurotic edema, urticaria, and pruritus
More on Escherichia Coli Infections |
| Overview: Escherichia Coli Infections |
| Differential Diagnoses & Workup: Escherichia Coli Infections |
 Treatment & Medication: Escherichia Coli Infections |
| Follow-up: Escherichia Coli Infections |
| Multimedia: Escherichia Coli Infections |
| References |
| « Previous Page | Next Page » |
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Further Reading
Keywords
E coli, Escherichia coli, traveler's diarrhea, traveler diarrhea, E coli cholecystitis, E coli bacteremia, E coli cholangitis, E coli urinary tract infection, E coli UTI, E coli neonatal meningitis, E coli pneumonia, E coli acute bacterial meningitis, E coli nosocomial pneumonia, E coli hospital-acquired pneumonia, E coli nosocomial infection, E coli hospital-acquired infection, E coli bronchopneumonia, enterotoxigenic E coli, ETEC, enteropathogenic E coli, EPEC, enteroinvasive E coli, EIEC, E coli dysentery
enterohemorrhagic E coli, EHEC, E coli hemorrhagic colitis, hemolytic-uremic syndrome, HUS, enteroaggregative E coli, EAggEC, enteroadherent E coli, EAEC, uncomplicated E coli urethritis, uncomplicated E coli cystitis, symptomatic E coli cystitis, E coli pyelonephritis, acute E coli prostatitis, E coli prostatic abscess, E coli urosepsis, E coli septic arthritis, E coli endophthalmitis, E coli suppurative thyroiditis, E coli sinusitis, E coli osteomyelitis, E coli endocarditis, E coli skin infection, E coli diabetic skin infection, E coli soft-tissue infection, E coli diarrheal disease
