From the Research
The recommended treatment for pediatric enteropathogenic Escherichia coli (EPEC) infections primarily involves supportive care with oral rehydration therapy to prevent and treat dehydration. This approach is based on the most recent and highest quality evidence available, which emphasizes the importance of rehydration in managing EPEC infections 1.
Key Considerations in Treatment
- Antibiotics are generally not recommended for routine cases as they may not shorten illness duration and could potentially increase the risk of hemolytic uremic syndrome in some E. coli infections.
- However, in severe or persistent cases, particularly in immunocompromised children, antibiotics such as trimethoprim-sulfamethoxazole or azithromycin may be considered.
- Fluid management is crucial, with oral rehydration solution given frequently in small amounts to replace ongoing losses.
- Breastfeeding should be continued throughout the illness.
- Probiotics like Lactobacillus GG or Saccharomyces boulardii may help reduce the duration of diarrhea.
- Nutritional support with age-appropriate foods should be resumed as soon as the child can tolerate it, avoiding high-sugar foods and beverages which may worsen diarrhea.
Pathophysiology and Treatment Rationale
EPEC causes diarrhea by attaching to intestinal epithelial cells and disrupting normal absorption, making rehydration the cornerstone of management while the immune system clears the infection 1. The virulence mechanisms and pathophysiology of the attaching and effacing lesion (A/E) and the type-three-secretion-system (T3SS) are complex but well-studied, highlighting the need for supportive care that addresses the symptoms and complications of the infection rather than solely targeting the pathogen.
Evidence Base
The recommendation for supportive care with oral rehydration therapy is supported by studies that have investigated the treatment of EPEC infections in children 2, 3, 4, 5. While these studies provide valuable insights into the epidemiology, pathogenesis, and potential treatments for EPEC infections, the most recent and highest quality evidence emphasizes the importance of rehydration and supportive care in managing these infections 1.