From the Guidelines
E. coli is typically sensitive to several classes of antibiotics, including carbapenems, such as meropenem 1g every 8 hours, and beta-lactam/beta-lactamase inhibitor combinations, such as piperacillin/tazobactam 4.5g every 6 hours, as recommended by the 2017 WSES guidelines for management of intra-abdominal infections 1. The choice of antibiotic should consider the infection site, severity, patient factors, and local resistance patterns.
- For patients with community-acquired intra-abdominal infections, agents with a narrower spectrum of activity are preferred, such as ertapenem, meropenem, or ticarcillin-clavulanate 1.
- In patients with healthcare-associated infections, antibiotic regimens with broader spectra of activity are preferred, such as imipenem-cilastatin, meropenem, or doripenem 1.
- The use of carbapenems should be limited to preserve activity of this class of antibiotics due to the concern of emerging carbapenem-resistance 1.
- Other options include aminoglycosides, particularly for suspected infections by gram-negative bacteria, and tigecycline, which has favorable in vitro activity against anaerobic organisms and enterococci 1.
- New antibiotics, such as ceftolozane/tazobactam and ceftazidime/avibactam, have been approved for treatment of complicated intra-abdominal infections, including infections by ESBL-producing Enterobacteriaceae and P. aeruginosa 1. It is essential to note that antibiotic resistance in E. coli is increasingly common, particularly to ampicillin, amoxicillin, and first-generation cephalosporins, and that obtaining cultures and sensitivity testing is crucial to guide appropriate therapy, as resistance patterns vary geographically and among different strains 1.
From the FDA Drug Label
E. coli has been shown to be active against most strains of the following microorganisms, both in vitro and in clinical infections The minimal bactericidal concentration (MBC) generally does not exceed the minimal inhibitory concentration (MIC) by more than a factor of 2 Ciprofloxacin has been shown to be active against most strains of the following microorganisms, both in vitro and in clinical infections as described in the INDICATIONS AND USAGE section of the package insert for Ciprofloxacin Hydrochloride Tablets USP, 250mg, 500mg and 750mg. Aerobic gram-negative microorganisms Escherichia coli Standard ciprofloxacin powder should provide the following MIC values: Organism MIC (μg/mL) E. coli ATCC 25922 0.004 – 0.015
E. coli is sensitive to ciprofloxacin with a MIC of 0.004 – 0.015 μg/mL 2.
- Ciprofloxacin is active against E. coli.
- The MIC values for E. coli are 0.004 – 0.015 μg/mL. Additionally, E. coli is also sensitive to ertapenem 3.
- Ertapenem has in vitro activity against Gram-positive and Gram-negative aerobic and anaerobic bacteria, including E. coli.
From the Research
Antibiotic Sensitivity of E. coli
- E. coli has been found to be sensitive to several antibiotics, including:
- Ceftriaxone, as shown in a study comparing ceftriaxone and levofloxacin for the treatment of E. coli urinary tract infections 4
- Levofloxacin, although resistance rates have increased in recent years 4, 5, 6
- Ciprofloxacin, with all E. coli isolates being susceptible in one study 7
- Ertapenem, with 100% susceptibility of E. coli isolates in another study 6
- Piperacillin-tazobactam, with high activity against E. coli isolates 6
- Amikacin, with synergy occurring when combined with levofloxacin or ciprofloxacin against ESBL-producing E. coli 5
- It is essential to note that antibiotic resistance patterns can vary depending on the location and specific strain of E. coli, and local antibiogram data should be consulted to guide treatment decisions 4, 6
Specific Antibiotic Combinations
- Combinations of antibiotics, such as levofloxacin or ciprofloxacin with amikacin or beta-lactams, have shown synergy against ESBL-producing E. coli 5
- The combination of ceftriaxone and azithromycin has been compared to gepotidacin for the treatment of uncomplicated urogenital gonorrhoea, although this study did not specifically focus on E. coli 8