From the Guidelines
Azithromycin is the recommended first-line treatment for enteroaggregative E. coli (EAEC) infections, particularly in cases with moderate to severe symptoms or dysentery, due to its efficacy and safety profile, as demonstrated in recent studies 1. When considering treatment for EAEC, it's essential to assess the severity of illness and the impact on the patient's activities and plans.
- The decision to treat should be based on the severity of symptoms, with moderate to severe cases requiring antimicrobial therapy.
- Azithromycin has been shown to be effective in treating EAEC, with a single 1-gm dose or 500 mg daily for 3 days being a recommended regimen 1.
- The choice of antibiotic should consider regional patterns of antimicrobial resistance, with azithromycin being a suitable option due to its efficacy against FQ-resistant Campylobacter and other bacterial causes of dysentery 1.
- Supportive care, including oral or intravenous rehydration, is crucial in managing EAEC infections to prevent dehydration and other complications.
- It's essential to complete the full course of antibiotics, even if symptoms improve before finishing treatment, to ensure the elimination of the bacteria and prevent recurrence.
- Other treatment options, such as fluoroquinolones, may be considered in specific cases, but their use should be guided by antimicrobial susceptibility testing and careful consideration of potential side effects and resistance patterns 1.
From the FDA Drug Label
XIFAXAN is indicated for the treatment of travelers’ diarrhea (TD) caused by noninvasive strains of Escherichia coli in adults and pediatric patients 12 years of age and older XIFAXAN should not be used in patients with diarrhea complicated by fever or blood in the stool or diarrhea due to pathogens other than Escherichia coli
The treatment of enteroaggregative E. coli is not explicitly mentioned in the drug label. However, it is a type of E. coli, and the label states that XIFAXAN is indicated for the treatment of travelers’ diarrhea caused by noninvasive strains of Escherichia coli.
- Enteroaggregative E. coli is a type of E. coli that can cause diarrhea, but it is not clear if it is considered a noninvasive strain.
- The label does not provide information on the effectiveness of XIFAXAN against enteroaggregative E. coli specifically. Therefore, based on the available information, it is unclear if XIFAXAN is effective against enteroaggregative E. coli 2.
From the Research
Treatment of Enteroaggregative E coli
- Enteroaggregative Escherichia coli (EAEC) is an emerging pathogen that causes enteric and food-borne infectious diseases, and its treatment should be individually based 3.
- All children with EAEC diarrhea should receive adequate oral fluid hydration, and antimicrobials may be initiated for those with persistent diarrhea and severe dehydrating illness despite adequate oral rehydration 3.
- Azithromycin and rifaximin have been shown to shorten the course of EAEC diarrhea in adults and are probably the recommended antimicrobials of choice for children with severe or persistent illness 3, 4.
- Ciprofloxacin is also an effective treatment for EAEC infection, but its use may be limited due to increasing resistance 4, 5, 6, 7.
- Rifaximin continues to be an effective treatment for EAEC infection, with low resistance rates 4, 6, 7.
Antimicrobial Resistance
- There is a growing concern about antimicrobial resistance in EAEC, with increasing resistance to traditional antibiotics such as ampicillin, trimethoprim-sulfamethoxazole, and doxycycline 6, 7.
- Resistance to fluoroquinolones, such as ciprofloxacin, has also increased, making them less effective for treating EAEC infections 6, 7.
- Azithromycin resistance is also a concern, particularly in EAEC isolates from patients traveling to Southeast Asia/India and Africa 7.
- Rifaximin remains a viable treatment option, with low resistance rates, making it a good alternative for treating EAEC infections 6, 7.