From the Guidelines
The treatment for E. coli infection in stool should prioritize azithromycin as the first-line agent, especially in cases of dysentery or severe infection, due to its efficacy and the increasing resistance of Campylobacter spp. to fluoroquinolones (FQs) 1. When considering the treatment for E. coli infection in stool, it's crucial to differentiate between uncomplicated and severe or persistent infections. Most uncomplicated E. coli diarrheal infections are self-limiting and require only supportive care, including rest and adequate fluid replacement to prevent dehydration. Oral rehydration solutions containing electrolytes are particularly effective.
- Antibiotics are generally not recommended for routine cases as they may prolong bacterial shedding, increase antibiotic resistance, and can potentially worsen certain infections like Shiga toxin-producing E. coli (STEC).
- However, for severe or persistent infections, particularly those caused by enterotoxigenic E. coli (ETEC) or enteroaggregative E. coli (EAEC), antibiotics such as azithromycin (500 mg once daily for 3 days) may be prescribed, considering its superior efficacy compared to FQs in certain settings 1.
- Patients should avoid anti-diarrheal medications like loperamide in cases of bloody diarrhea or suspected STEC infection as these can delay toxin clearance and potentially increase complications.
- During recovery, a bland diet that's easy to digest may help, gradually reintroducing normal foods as symptoms improve.
- Hand hygiene and proper food handling are essential to prevent transmission to others. It's also important to consider the potential risks associated with antibiotic use, such as the development of Clostridioides difficile infection (CDI), and to take measures to prevent its spread, including hand hygiene with soap and water, and the use of contact precautions 1.
From the FDA Drug Label
Infectious Diarrhea caused by Escherichia coli (enterotoxigenic strains), Campylobacter jejuni, Shigella boydii†, Shigella dysenteriae, Shigella flexneri or Shigella sonnei† when antibacterial therapy is indicated.
The treatment for Escherichia coli (E. coli) infection in stool is ciprofloxacin when antibacterial therapy is indicated, specifically for infectious diarrhea caused by enterotoxigenic strains of E. coli 2.
From the Research
Treatment Options for E. coli Infection in Stool
- Antibiotic therapy is a common treatment approach for E. coli infections, with azithromycin being the preferred first-line antibiotic 3, 4.
- Azithromycin can be used to treat acute watery diarrhea, febrile diarrhea, and dysentery, with dosages ranging from 500 mg to 1,000 mg 3.
- Other antibiotic options include levofloxacin and ciprofloxacin, although their effectiveness may be limited due to increasing fluoroquinolone resistance 3, 5.
- Loperamide can be used in combination with antibiotic treatment to further reduce gastrointestinal symptoms and duration of illness 3, 5.
- Probiotics, such as Saccharomyces boulardii and Lactobacillus acidophilus, may also be effective in treating antibiotic-associated diarrhea 6.
Specific Treatment Approaches for E. coli Diarrhea
- A study on cancer patients with EPEC diarrhea found that azithromycin and ciprofloxacin were effective treatment options 4.
- Another study on travelers' diarrhea found that ciprofloxacin plus loperamide was not significantly better than ciprofloxacin alone in treating the condition 5.