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Pediatric Escherichia Coli Infections Treatment & Management

  • Author: Archana Chatterjee, MD, PhD; Chief Editor: Russell W Steele, MD  more...
Updated: Oct 07, 2015

Medical Care

Treatment of bacterial gastroenteritis is primarily supportive and directed toward maintaining hydration and electrolyte balance. Antibiotic therapy is rarely indicated and should be deferred until culture results are available.

Oral rehydration therapy (ORT) is the preferred treatment for fluid and electrolyte losses caused by diarrhea in children with mild-to-moderate dehydration. Intravenous hydration is often administered for severe dehydration or when vomiting prevents ORT. In most cases, even children who are vomiting can tolerate oral fluids if administered frequently in small amounts.[27, 28]

  • Do not use antimotility agents to treat acute diarrhea in pediatric patients. Antimotility agents may prolong the clinical and bacteriologic course of the disease and may be associated with other unacceptable morbidities such as excessive sedation. A retrospective study reported hemolytic-uremic syndrome (HUS) was more likely to develop in patients with E coli 0157:H7 infection who received antimotility agents.[29]
  • Antibiotic treatment of E coli 0157:H7 colitis is controversial. Early data indicated antimicrobials offer no substantial benefit and may increase the risk of developing HUS.[29] In vitro studies have shown subinhibitory antibiotic concentrations can increase toxin production.[30] However, a subsequent meta-analysis reported no association between the use of antimicrobials and higher risk of HUS.[31] In the absence of conclusive evidence, empiric antibiotics should not be administered due to the potential risk of HUS.[2]
  • Administer intravenous antibiotics to children who have evidence of systemic infection (eg, bacteremia, sepsis). Include a combination of ampicillin and an aminoglycoside in the initial empiric treatment of a neonate with suspected sepsis. Alternative regimens of ampicillin and a cephalosporin, such as cefotaxime, are also acceptable. Coverage may be narrowed when the etiologic agent and its antimicrobial susceptibilities have been determined. Base therapy duration on the patient's response and established treatment guidelines (usually 10-14 d for uncomplicated sepsis, >21 d for meningitis).[2]
  • Urinary tract infections (UTIs) may be treated with oral antibiotics if the child can tolerate oral medication without vomiting. Antibiotic regimens of 3 days are inadequate; continue treatment for 10 days.
  • Treatment of HUS is supportive and includes management of fluid and electrolyte status and dialysis, if necessary. Ake et al (2005) propose that early volume expansion with parenteral isotonic fluids during the pre-HUS interval is essential to attenuate renal injury associated with HUS.[32] Leukocytosis has been identified as an early predictor of the development of HUS following an E coli O157:H7 infection.[33, 34]


See the list below:

  • In cases of hemorrhagic colitis, consultation with a pediatric infectious disease specialist is recommended, especially if considering antibiotic therapy.
  • When HUS is suspected or confirmed, a pediatric nephrologist should assist with patient management because dialysis may be necessary. Early dialysis is associated with improved outcome.
  • Ongoing research protocols investigating the benefit of a toxin-adsorbing preparation appear promising.[30] Enrollment in such a treatment study may be an option at selected tertiary care settings.


See the list below:

  • Children who have diarrhea should continue to receive age-appropriate diets.
  • Feed dehydrated children as soon as they have been rehydrated.
  • Feeding may be withheld briefly for children who are vomiting, but prolonged periods of fasting or specialized diets are unnecessary once vomiting ceases.


See the list below:

  • Increase allowable activities, as tolerated, for all affected children. In general, children eagerly resume vigorous activity as their illness resolves and restrictions are unnecessary.
  • Children with E coli 0157:H7 infection should not return to group childcare settings until the diarrhea has resolved and 2 stool culture results are negative.
Contributor Information and Disclosures

Archana Chatterjee, MD, PhD Professor and Chair, Department of Pediatrics, Senior Associate Dean for Faculty Development, Sanford School of Medicine, The University of South Dakota

Archana Chatterjee, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, International Society for Infectious Diseases, Pediatric Infectious Diseases Society, Society for Pediatric Research

Disclosure: Nothing to disclose.


Sara L Cuthill, MD Fellow, Developmental and Behavioral Pediatrics, Departmental and Behavioral Pediatrics, Interstate Medical Office East

Sara L Cuthill, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Meera Varman, MD Associate Professor, Department of Pediatrics, Section of Pediatric Infectious Diseases, Creighton University Medical Center

Meera Varman, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Society for Healthcare Epidemiology of America

Disclosure: Received honoraria from phamaceutical companies for speaking and teaching; Received grant/research funds from phamaceutical companies for clinical trials research.

Catherine O’Keefe, DNP, APRN-NP Associate Professor of Nursing, Clinician-Educator Track Graduate Curriculum Coordinator, Nurse Practitioner Programs, Creighton University, School of Nursing; Pediatric Nurse Practitioner, Pediatric Infectious Diseases, Creighton University Medical Center

Catherine O’Keefe, DNP, APRN-NP is a member of the following medical societies: American Association of Nurse Practitioners, National Association of Pediatric Nurse Practitioners, Nebraska Nurse Practitioners

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Mark R Schleiss, MD Minnesota American Legion and Auxiliary Heart Research Foundation Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School

Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Ashir Kumar, MD, MBBS FAAP, Professor Emeritus, Department of Pediatrics and Human Development, Michigan State University College of Human Medicine

Ashir Kumar, MD, MBBS is a member of the following medical societies: Infectious Diseases Society of America, American Association of Physicians of Indian Origin

Disclosure: Nothing to disclose.

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