What is the treatment for Escherichia coli (E. coli) in stool?

From the Guidelines

Azithromycin should be considered the first-line agent for the treatment of E. coli in stool, particularly in cases of dysentery or acute watery diarrhea with greater than mild fever, due to its high efficacy and safety profile 1. The treatment for E. coli in stool depends on the specific strain and severity of infection. Most uncomplicated E. coli infections are self-limiting and require only supportive care including rest, increased fluid intake to prevent dehydration, and electrolyte replacement if needed.

• Key considerations in the selection of an empiric antibiotic include the likelihood of treatment efficacy and rapidity of response, regional patterns of probable target pathogens and their antimicrobial resistance, safety and tolerance profile of the antibiotic, simplicity of treatment regimen, and cost 1.
• Azithromycin has been shown to be superior to levofloxacin in achieving clinical cure in settings with high rates of FQ-resistant Campylobacter spp. and other bacterial causes such as Shigella spp., enteroinvasive E. coli, Aeromonas spp., Plesiomonas spp., and Yersinia enterocolitica 1.
• The recommended dose of azithromycin is a single 1-gm dose or 500 mg daily for 3 days, which has been demonstrated to be effective and well-tolerated with minimal side effects 1.
• Patients should practice strict hand hygiene to prevent transmission to others and should avoid preparing food for others while symptomatic.
• Medical attention should be sought immediately if symptoms include bloody diarrhea, severe abdominal pain, high fever, or signs of dehydration like decreased urination or extreme thirst.

From the FDA Drug Label

To reduce the development of drug-resistant bacteria and maintain the effectiveness of sulfamethoxazole and trimethoprim tablets and other antibacterial drugs, sulfamethoxazole and trimethoprim tablets should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria Urinary Tract Infections: For the treatment of urinary tract infections due to susceptible strains of the following organisms: Escherichia coli, Traveler’s Diarrhea in Adults: For the treatment of traveler’s diarrhea due to susceptible strains of enterotoxigenic E. coli.

The treatment for Escherichia coli (E. coli) in stool is Trimethoprim-sulfamethoxazole (PO), specifically for traveler’s diarrhea due to susceptible strains of enterotoxigenic E. coli 2.

• Key points:
  • The drug is used to treat infections caused by susceptible bacteria
  • It is effective against E. coli in the treatment of urinary tract infections and traveler’s diarrhea
  • The treatment should only be used when the infection is proven or strongly suspected to be caused by susceptible bacteria 2

From the Research

Treatment for E. coli in Stool

The treatment for Escherichia coli (E. coli) in stool depends on the severity of the symptoms and the type of E. coli infection.

• For uncomplicated urinary tract infections (UTIs) caused by E. coli, the recommended first-line empiric antibiotic therapy is a 5-day course of nitrofurantoin, a 3-g single dose of fosfomycin tromethamine, or a 5-day course of pivmecillinam 3.
• For acute watery diarrhea caused by E. coli, azithromycin is the preferred first-line antibiotic, with a single dose of 500 mg 4.
• Ciprofloxacin is also an option for acute watery diarrhea, with a single dose of 750 mg, but its use is becoming less effective due to increasing fluoroquinolone resistance 4, 5.
• Trimethoprim-sulfamethoxazole is another option for treating E. coli infections, but its use is limited due to high rates of resistance 3, 6, 7.
• Rifaximin is an alternative for acute watery diarrhea, with a dose of 200 mg three times a day for 3 days, but it should not be used with invasive illness 4.
• Loperamide can be used in combination with antibiotic treatment to further reduce gastrointestinal symptoms and duration of illness 4.

Considerations for Treatment

• The choice of antibiotic should take into account the travel destination and regional differences in the predominance of pathogens and resistance levels 4.
• The treatment should be guided by the severity of symptoms, the type of E. coli infection, and the patient's medical history and allergies.
• It is essential to use antibiotics wisely to avoid resistance development 3.