Pediatric Escherichia Coli Infections Medication
- Author: Archana Chatterjee, MD, PhD; Chief Editor: Russell W Steele, MD more...
Antibiotic therapy is not indicated in most cases of Escherichia coli enteritis; guidelines for specific circumstances are outlined below.
Antimotility agents are contraindicated for all cases of pediatric gastroenteritis.
Urinary tract infections (UTIs) may be treated with various oral antibiotics, most commonly trimethoprim and sulfamethoxazole, amoxicillin, or cefixime. Duration of therapy is 10 days.
Neonatal sepsis and meningitis are treated based on identified organism susceptibility and clinical response.
Treatment of traveler's diarrhea is rarely necessary. Prophylaxis for traveler's diarrhea with medications (eg, bismuth subsalicylate, trimethoprim and sulfamethoxazole) is not recommended for children because of potential salicylate accumulation and allergic reactions. Efficacy of antibiotic treatment of enteroinvasive E coli (EIEC) and enterohemorrhagic E coli (EHEC) is not established. Data suggest treating EHEC does not alter the course of infection and increases risk of subsequent hemolytic-uremic syndrome (HUS). UTI in infants and children is treated for 10 days because of the difficulty distinguishing between uncomplicated cystitis and pyelonephritis.
First-line therapy for UTI and most E coli diarrheal illness; resistant organisms are fairly common.
Reasonable choice to treat pediatric UTI. Liquid preparation is palatable and well tolerated. It is concentrated in the urine and active against most gram-positive and some gram-negative organisms.
Third-generation cephalosporin is a second-line choice to treat UTI or traveler's diarrhea; liquid preparation is pleasant tasting.
Administer parenterally in combination with an aminoglycoside or cephalosporin in cases of neonatal sepsis or meningitis; PO preparation is a second-line therapy for traveler's diarrhea and dysentery.
Aminoglycoside antibiotic used in combination with ampicillin to treat neonatal sepsis and meningitis; provides gram-negative coverage and works synergistically against gram-positives.
Third-generation cephalosporin administered parenterally in combination with ampicillin to treat neonatal sepsis or meningitis.
Quinolone antibiotics are an alternative therapy for adult UTI or bacterial enteritis. Use is contraindicated in pediatric patients when an acceptable alternative is available.
Nonabsorbed (< 0.4%), broad-spectrum antibiotic specific for enteric pathogens of the GI tract (ie, gram-positive, gram-negative, aerobic and 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 traveler's diarrhea.
Nataro JP. Escherichia coli. Long S, Pickering LK, Prober CG (Editors). Principles and Practice of Pediatric Infectious Diseases. 3rd Edition. Orlando, Fl: Churchill Livingstone; 2008.
Escherichia coli diarrhea. Pickering LK, Baker CJ, Overturf GD, Prober CG (Editors). American Academy of Pediatricians Report of the Committee on Infectious Diseases. Red Book. 2008. 291-6.
Centers for Disease Control and Prevention. Preliminary FoodNet data on the incidence of infection with pathogens transmitted commonly through food--10 states, 2007. MMWR Morb Mortal Wkly Rep. 2008 Apr 11. 57(14):366-70. [Medline].
WHO. Enterotoxigenic escherichia coli. World Health Organization. Available at http://www.who.int/vaccine_research/diseases/e_e_coli/en/. Accessed: 10/01/2008.
Gupta SK, Keck J, Ram PK, Crump JA, Miller MA, Mintz ED. Part III. Analysis of data gaps pertaining to enterotoxigenic Escherichia coli infections in low and medium human development index countries, 1984-2005. Epidemiol Infect. 2008 Jun. 136(6):721-38. [Medline].
Qadri F, Svennerholm AM, Faruque AS, et al. Enterotoxigenic Escherichia coli in developing countries: epidemiology, microbiology, clinical features, treatment, and prevention. Clin Microbiol Rev. 2005 Jul. 18(3):465-83. [Medline].
Bolin I, Wiklund G, Qadri F, et al. Enterotoxigenic Escherichia coli with STh and STp genotypes is associated with diarrhea both in children in areas of endemicity and in travelers. J Clin Microbiol. 2006 Nov. 44(11):3872-7. [Medline].
Rockabrand DM, Shaheen HI, Khalil SB, et al. Enterotoxigenic Escherichia coli colonization factor types collected from 1997 to 2001 in US military personnel during operation Bright Star in northern Egypt. Diagn Microbiol Infect Dis. 2006 May. 55(1):9-12. [Medline].
Yolbas I, Tekin R, Kelekci S, Tekin A, Okur MH, Ece A, et al. Community-acquired urinary tract infections in children: pathogens, antibiotic susceptibility and seasonal changes. Eur Rev Med Pharmacol Sci. 2013 Apr. 17(7):971-6. [Medline].
Canizalez-Roman A, Gonzalez-Nuñez E, Vidal JE, Flores-Villaseñor H, León-Sicairos N. Prevalence and antibiotic resistance profiles of diarrheagenic Escherichia coli strains isolated from food items in northwestern Mexico. Int J Food Microbiol. 2013 Mar 27. 164(1):36-45. [Medline].
Buchholz U, Bernard H, Werber D, et al. German Outbreak of Escherichia coli O104:H4 Associated with Sprouts. N Engl J Med. 2011 Oct 26. [Medline].
Frank C, Werber D, Cramer JP, et al. Epidemic Profile of Shiga-Toxin-Producing Escherichia coli O104:H4 Outbreak in Germany. N Engl J Med. 2011 Jun 22. [Medline].
Centers for Disease Control and Prevention. Escherichia coli O157:H7 infection associated with drinking raw milk--Washington and Oregon, November-December 2005. MMWR Morb Mortal Wkly Rep. 2007 Mar 2. 56(8):165-7. [Medline].
Rossit AR, de Almeida MT, Nogueira CA, et al. Bacterial, yeast, parasitic, and viral enteropathogens in HIV-infected children from São Paulo State, Southeastern Brazil. Diagn Microbiol Infect Dis. 2007 Jan. 57(1):59-66. [Medline].
Gassama A, Sow PS, Fall F, et al. Ordinary and opportunistic enteropathogens associated with diarrhea in Senegalese adults in relation to human immunodeficiency virus serostatus. Int J Infect Dis. 2001. 5(4):192-8. [Medline].
Hien BT, Scheutz F, Cam PD, et al. Diarrheagenic Escherichia coli and Shigella strains isolated from children in a hospital case-control study in Hanoi, Vietnam. J Clin Microbiol. 2008 Mar. 46(3):996-1004. [Medline].
Al-Gallas N, Bahri O, Bouratbeen A, et al. Etiology of acute diarrhea in children and adults in Tunis, Tunisia, with emphasis on diarrheagenic Escherichia coli: prevalence, phenotyping, and molecular epidemiology. Am J Trop Med Hyg. 2007 Sep. 77(3):571-82. [Medline].
Kim MJ, Kim SA, Kang YS, Hwang IG, Rhee MS. Microbial diversity and prevalence of foodborne pathogens in cheap and junk foods consumed by primary schoolchildren. Lett Appl Microbiol. 2013 Apr 1. [Medline].
Centers for Disease Control and Prevention. Escherichia coli 0157:H7 infections in children associated with raw milk and raw colostrum from cows--California, 2006. MMWR Morb Mortal Wkly Rep. 2008 Jun 13. 57(23):625-8. [Medline].
Centers for Disease Control and Prevention. Ongoing multistate outbreak of Escherichia coli serotype O157:H7 infections associated with consumption of fresh spinach--United States, September 2006. MMWR Morb Mortal Wkly Rep. 2006 Sep 29. 55(38):1045-6. [Medline].
Diarrheagenic Escherichia coli. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/ncidod/dbmd/diseaseinfo/diarrecoli_t.htm. Accessed: October 1, 2008.
Serna A 4th, Boedeker EC. Pathogenesis and treatment of Shiga toxin-producing Escherichia coli infections. Curr Opin Gastroenterol. 2008 Jan. 24(1):38-47. [Medline].
Zhang W, Bielaszewska M, Pulz M, et al. New immuno-PCR assay for detection of low concentrations of shiga toxin 2 and its variants. J Clin Microbiol. 2008 Apr. 46(4):1292-7. [Medline].
Beutin L, Steinruck H, Krause G, et al. Comparative evaluation of the Ridascreen Verotoxin enzyme immunoassay for detection of Shiga-toxin producing strains of Escherichia coli (STEC) from food and other sources. J Appl Microbiol. 2007 Mar. 102(3):630-9. [Medline].
Lothigius A, Janzon A, Begum Y, et al. Enterotoxigenic Escherichia coli is detectable in water samples from an endemic area by real-time PCR. J Appl Microbiol. 2008 Apr. 104(4):1128-36. [Medline].
Morgan J, Bell M, Sadler MA. CT imaging of acute E. Coli-related colitis. Emerg Radiol. 2007 Jul. 14(3):187-9. [Medline].
Kliegman RM, Behrman RE, Jenson HB, et al. The pathophysiology of body fluids and fluid therapy. Nelson Textbook of Pediatrics, 18th ed. Elsevier Health Sciences,. 2007. Ch. 55.1.
Wong CS, Jelacic S, Habeeb RL, et al. The risk of the hemolytic-uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 infections. N Engl J Med. 2000 Jun 29. 342(26):1930-6. [Medline].
Scheiring J, Andreoli SP, Zimmerhackl LB. Treatment and outcome of Shiga-toxin-associated hemolytic uremic syndrome (HUS). Pediatr Nephrol. 2008 Oct. 23(10):1749-60. [Medline].
Safdar N, Said A, Gangnon RE, Maki DG. Risk of hemolytic uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 enteritis: a meta-analysis. JAMA. 2002 Aug 28. 288(8):996-1001. [Medline].
Ake JA, Jelacic S, Ciol MA, et al. Relative nephroprotection during Escherichia coli O157:H7 infections: association with intravenous volume expansion. Pediatrics. 2005 Jun. 115(6):e673-80. [Medline].
Anjay MA, Anoop P, Britland A. Leukocytosis as a predictor for progression to haemolytic uraemic syndrome in Escherichia coli O157:H7 infection. Arch Dis Child. 2007 Sep. 92(9):820-3. [Medline].
Joishy M, Jauhari P, Mathew AA, et al. Can we predict the development of haemolytic uraemic syndrome in the early stage of Escherichia coli O157 infection?. Arch Dis Child. 2008 Feb. 93(2):180-1. [Medline].
Saps M, Pensabene L, Di Martino L, et al. Post-infectious functional gastrointestinal disorders in children. J Pediatr. 2008 Jun. 152(6):812-6, 816.e1. [Medline].
Frech SA, Dupont HL, Bourgeois AL, et al. Use of a patch containing heat-labile toxin from Escherichia coli against travellers' diarrhoea: a phase II, randomised, double-blind, placebo-controlled field trial. Lancet. 2008 Jun 14. 371(9629):2019-25. [Medline].
Glenn GM, Villar CP, Flyer DC, et al. Safety and immunogenicity of an enterotoxigenic Escherichia coli vaccine patch containing heat-labile toxin: use of skin pretreatment to disrupt the stratum corneum. Infect Immun. 2007 May. 75(5):2163-70. [Medline].
Ahmed A, Li J, Shiloach Y, et al. Safety and immunogenicity of Escherichia coli O157 O-specific polysaccharide conjugate vaccine in 2-5-year-old children. J Infect Dis. 2006 Feb 15. 193(4):515-21. [Medline].
Amieva MR. Important bacterial gastrointestinal pathogens in children: a pathogenesis perspective. Pediatr Clin North Am. 2005 Jun. 52(3):749-77, vi. [Medline].
Blackall DP, Marques MB. Hemolytic uremic syndrome revisited: Shiga toxin, factor H, and fibrin generation. Am J Clin Pathol. 2004 Jun. 121 Suppl:S81-8. [Medline].
David RD, DeBlieux PM, Press R. Rational antibiotic treatment of outpatient genitourinary infections in a changing environment. Am J Med. 2005 Jul. 118 Suppl 7A:7S-13S. [Medline].
Investigation of multistate outbreak of E. coli O157:H7 infections: Updated July 18, 2008. Centers for Disease Control and Prevention. Available at http://www.cdc.gov/ecoli/june2008outbreak/. Accessed: September 30, 2008.
Li F, Zhao C, Zhang W, et al. Use of ramification amplification assay for detection of Escherichia coli O157:H7 and other E. coli Shiga toxin-producing strains. J Clin Microbiol. 2005 Dec. 43(12):6086-90. [Medline]. [Full Text].
Mehnert-Kay SA. Diagnosis and management of uncomplicated urinary tract infections. Am Fam Physician. 2005 Aug 1. 72(3):451-6. [Medline].
Stoll BJ, Hansen N. Infections in VLBW infants: studies from the NICHD Neonatal Research Network. Semin Perinatol. 2003 Aug. 27(4):293-301. [Medline].
Tarr PI, Gordon CA, Chandler WL. Shiga-toxin-producing Escherichia coli and haemolytic uraemic syndrome. Lancet. 2005 Mar 19-25. 365(9464):1073-86. [Medline].
Vidal M, Kruger E, Duran C, et al. Single multiplex PCR assay to identify simultaneously the six categories of diarrheagenic Escherichia coli associated with enteric infections. J Clin Microbiol. 2005 Oct. 43(10):5362-5. [Medline]. [Full Text].
Yates J. Traveler's diarrhea. Am Fam Physician. 2005 Jun 1. 71(11):2095-100. [Medline].
Yada N, Fujioka M, Bennett CL, Inoki K, Miki T, Watanabe A, et al. STEC:O111-HUS complicated by acute encephalopathy in a young girl was successfully treated with a set of hemodiafiltration, steroid pulse, and soluble thrombomodulin under plasma exchange. Clin Case Rep. 2015 Apr. 3 (4):208-12. [Medline]. [Full Text].
Takanashi J, Taneichi H, Misaki T, Yahata Y, Okumura A, Ishida Y, et al. Clinical and radiologic features of encephalopathy during 2011 E coli O111 outbreak in Japan. Neurology. 2014 Feb 18. 82 (7):564-72. [Medline].
Pape L, Hartmann H, Bange FC, Suerbaum S, Bueltmann E, Ahlenstiel-Grunow T. Eculizumab in Typical Hemolytic Uremic Syndrome (HUS) With Neurological Involvement. Medicine (Baltimore). 2015 Jun. 94 (24):e1000. [Medline].
Dinh A, Anathasayanan A, Rubin LM. Safe and effective use of eculizumab in the treatment of severe Shiga toxin Escherichia coli-associated hemolytic uremic syndrome. Am J Health Syst Pharm. 2015 Jan 15. 72 (2):117-20. [Medline].
Delmas Y, Vendrely B, Clouzeau B, Bachir H, Bui HN, Lacraz A, et al. Outbreak of Escherichia coli O104:H4 haemolytic uraemic syndrome in France: outcome with eculizumab. Nephrol Dial Transplant. 2014 Mar. 29 (3):565-72. [Medline]. [Full Text].