Treatment for EHEC in Children
Antibiotics should NOT be used to treat Enterohemorrhagic Escherichia coli (EHEC) infections in children, as they increase the risk of hemolytic uremic syndrome (HUS) and do not shorten the illness course. 1, 2
Primary Management Approach
Supportive Care Only
- Provide aggressive rehydration and supportive therapy as the cornerstone of treatment 1, 3
- Monitor fluid and electrolyte balance closely, particularly in children under 10 years of age who have approximately 10% risk of developing HUS 1, 4
- Clinical symptoms typically last about 2 weeks and resolve naturally with supportive care alone 5
Strict Avoidance of Contraindicated Medications
Do NOT use the following agents, as they worsen outcomes:
- Antimicrobial agents - Meta-analyses of low-risk-of-bias studies demonstrate clear association between antibiotic use and increased HUS development 2
- Antimotility agents (e.g., loperamide) - These neither shorten illness duration nor prevent sequelae, and may increase toxin exposure 1
- Narcotic analgesics - Avoid for the same reasons as antimotility agents 1
Clinical Monitoring Strategy
Surveillance for HUS Development
- Monitor for the triad of HUS: microangiopathic hemolytic anemia, thrombocytopenia, and acute renal failure 3
- Young children are at highest risk for HUS complications, which can be fatal if not recognized early 5, 4
- Check complete blood count, platelet count, renal function (creatinine, BUN), and peripheral blood smear for schistocytes if HUS is suspected 3
Diagnostic Confirmation
- Obtain stool culture for definitive diagnosis by isolation and identification of EHEC 1
- Look for history of bloody diarrhea, abdominal cramps, fever, and abdominal tenderness 5
- Rapid identification technology now enables earlier detection of STEC-infected patients 2
Key Clinical Pitfalls
The most critical error is prescribing antibiotics for acute bloody diarrhea before excluding STEC infection. In high-income countries, do not give antibiotics to patients with acute diarrhea unless testing demonstrates a pathogen for which antibiotics are indicated AND STEC infection has been excluded 2. The mechanism of harm is that antibiotics may increase Shiga toxin release from bacterial lysis, thereby increasing systemic toxin exposure and endothelial damage 4, 2.
Pathophysiology Considerations
- The microvascular endothelium is the major histopathological target of Shiga toxin 4
- EHEC produces both Shiga toxin and other virulence factors like cytolethal distending toxin that contribute to endothelial injury 4
- The cascade from gastrointestinal infection to renal impairment is complex, explaining why there are no specific therapies beyond supportive care 4
Prevention Focus
Since no specific therapies exist for EHEC infections, prevention strategies are paramount 4. Educate families about transmission through contaminated food sources (particularly undercooked ground beef and unpasteurized dairy products) and infected humans/animals 1, 3.