Pediatric Escherichia Coli Infections Treatment & Management

Updated: Mar 19, 2019
  • Author: Archana Chatterjee, MD, PhD; Chief Editor: Russell W Steele, MD  more...
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Treatment

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]

  • A systematic review and meta-analysis by Grisaru et al that included 1,511 children reported that the lack of intravenous fluid administration prior to establishment of HUS and a higher hematocrit value at presentation were predictors of poor outcomes for shiga toxin-producing Escherichia coli infected children. [35]

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Consultations

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  • 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.

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Diet

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  • 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.

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Activity

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  • 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.

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