From the Guidelines
For treating E. coli infections, particularly in the context of uncomplicated urinary tract infections, nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole for 3 days, or a single dose of fosfomycin are recommended as first-line options. These recommendations are based on the most recent guidelines from the American College of Physicians, as outlined in the study published in the Annals of Internal Medicine in 2021 1. The choice of antibiotic should target Escherichia coli, which accounts for more than 75% of all bacterial cystitis.
- Key considerations include:
- The duration of treatment, which can vary from a single dose to 5 or more days, depending on the antibiotic chosen.
- The type of infection, with uncomplicated cystitis and pyelonephritis having different treatment recommendations.
- Resistance patterns, which can influence the choice of antibiotic, although the provided evidence does not delve into specific resistance patterns.
- It's also important to note that fluoroquinolones, while efficacious, are not recommended for empirical use due to their high propensity for adverse effects and should be reserved for patients with a history of resistant organisms 1.
- The treatment of pyelonephritis, which occurs in more than 250,000 patients in the United States yearly, recommends either an oral fluoroquinolone for 7 days or trimethoprim-sulfamethoxazole for 14 days for patients not requiring hospitalization, as per the IDSA/ESCMID guideline mentioned in the study 1.
From the FDA Drug Label
Ceftriaxone for Injection is indicated for the treatment of the following infections when caused by susceptible organisms: ... Escherichia coli... URINARY TRACT INFECTIONS (complicated and uncomplicated) Caused by Escherichia coli, Proteus mirabilis, Proteus vulgaris, Morganella morganii or Klebsiella pneumoniae BACTERIAL SEPTICEMIA Caused by ... Escherichia coli, ... BONE AND JOINT INFECTIONS Caused by ... Escherichia coli, ... INTRA-ABDOMINAL INFECTIONS Caused by Escherichia coli, ...
Ceftriaxone is a good antibiotic for E. coli infections, including:
- Urinary tract infections
- Bacterial septicemia
- Bone and joint infections
- Intra-abdominal infections 2
From the Research
Antibiotic Options for E. coli
- Fosfomycin, nitrofurantoin, and temocillin have been shown to be effective against E. coli, with susceptibility rates of 100%, 99.4%, and 96.8%, respectively 3.
- Nitrofurantoin has been found to retain antimicrobial activity against multidrug-resistant urinary E. coli, with resistance rates of only 2.1% to 24.1% in isolates resistant to three, four, or five antimicrobial agents 4.
- Ciprofloxacin and trimethoprim-sulfamethoxazole have been found to have higher resistance rates, with 22% and 29.2% of E. coli isolates resistant to these antibiotics, respectively 3.
- Amikacin and fosfomycin have been found to have no or low resistance against E. coli, with resistance rates of 0% 5.
Factors Associated with Antibiotic Resistance
- Previous use of extended-spectrum penicillins and sulfonamides has been associated with trimethoprim resistance in E. coli 6.
- Recurrent UTI, genitourinary abnormalities, and previous use of trimethoprim-sulfamethoxazole within 90 days have been identified as predictors of trimethoprim-sulfamethoxazole resistance in E. coli 7.
- Prior fluoroquinolone use and complicated UTI have been found to increase the odds of ciprofloxacin resistance in E. coli 5.
Recommended Antibiotic Therapy
- Nitrofurantoin is recommended as a first-line agent for the empirical treatment of acute uncomplicated cystitis due to its consistent antimicrobial activity against multidrug-resistant E. coli 4.
- Fosfomycin and temocillin may also be considered as therapeutic options for uncomplicated community-acquired urinary tract infections, especially for lower UTI 3.