From the Guidelines
The treatment of EPEC primarily involves supportive care with oral rehydration therapy, and for severe cases, azithromycin is recommended as the first-line antibiotic due to its efficacy and safety profile. When considering the treatment of EPEC, it is essential to assess the severity of illness and the impact on the patient's activities and plans 1. The use of antibiotics such as azithromycin has been shown to reduce symptom duration and is efficacious in moderate to severe acute bacterial diarrhea 1. Key considerations in selecting an empiric antibiotic include the likelihood of treatment efficacy, regional patterns of probable target pathogens and their antimicrobial resistance, safety and tolerance profile, simplicity of treatment regimen, and cost 1. Some of the key points to consider when treating EPEC include:
- Azithromycin has been demonstrated to be superior to levofloxacin in achieving clinical cure in settings with high rates of FQ-resistant Campylobacter spp. 1
- Azithromycin is generally well tolerated with minimal side effects, usually dose-related gastrointestinal complaints 1
- FQs retain efficacy in much of the developing world but have concerns regarding reduced benefit due to the likelihood of FQ-resistant Campylobacter spp. or Shigella spp. being the cause of dysentery 1
- Rifaximin, a nonabsorbable antibiotic, has demonstrated comparable efficacy to FQs in non-invasive TD caused by diarrheagenic E. coli but is less effective for the treatment of invasive pathogens 1 In terms of specific treatment regimens, azithromycin (single 1-gm dose or 500 mg daily for 3 days) is recommended as the first-line agent in cases of dysentery and acute watery diarrhea with greater than mild fever 1. It is crucial to maintain adequate fluid and electrolyte balance and consider the use of probiotics to restore gut flora 1. Prevention through proper hygiene, safe food handling, and clean water is also essential, especially in childcare settings and developing regions where EPEC is more prevalent 1.
From the Research
Treatment of EPEC
- The treatment of Enteropathogenic Escherichia coli (EPEC) diarrhea is not clearly delineated in the literature, especially in cancer patients 2.
- A study reported the successful treatment of EPEC diarrhea in cancer patients using azithromycin in two cases and ciprofloxacin in one case 2.
- For dehydration caused by gastroenteritis, oral rehydration therapy (ORT) is recommended as the first-line treatment, and it has been shown to be as effective as intravenous fluid therapy (IVF) in moderately dehydrated children 3, 4.
- Rapid intravenous rehydration (RIR) is also a safe and effective treatment for children with mild to moderate dehydration secondary to acute gastroenteritis, unless contraindicated or in cases of acute severe comorbidity 5.
- The use of RIR is recommended when oral rehydration has failed or is contraindicated, and isotonic fluids such as saline solution supplemented with glucose (2.5%) are suggested 5.
- A rhythm of 20 cc/kg/h is recommended for 1-4 hours for RIR 5.
Rehydration Therapy
- ORT has been shown to be non-inferior to IVF for rehydration of moderately dehydrated children due to gastroenteritis in the emergency department 3.
- ORT demonstrated non-inferiority for successful rehydration at 4 hours and hospitalization rate, and therapy was initiated more quickly for ORT patients 3.
- A systematic review found that ORT had a higher risk of paralytic ileus, while IVT had a higher risk of phlebitis 4.
- The choice of rehydration therapy depends on the severity of dehydration, the patient's age and underlying medical conditions, and the availability of resources 6, 5.