What is the treatment for Enteroaggregative Escherichia coli (E. coli) infection?

From the Guidelines

Treatment for enteroaggregative E. coli (EAEC) is generally not recommended with antibiotics due to the lack of clear evidence on their effectiveness, and the primary approach should be supportive care with oral rehydration therapy. According to the provided evidence 1, the treatment for EAEC is listed as "Unknown" for immunocompetent patients and "Consider fluoroquinolone as for enterotoxigenic E. coli" for immunocompromised patients, but with a low level of evidence (C-III).

Key Considerations

• The use of antimotility agents is not recommended for certain types of bacterial infections, such as STEC, due to the risk of worsening the condition or developing Hemolytic Uremic Syndrome (HUS) 1.
• For other types of bacterial infections, such as Shigella species, TMP-SMZ or fluoroquinolones are recommended as first-line treatments 1.
• The treatment of EAEC should focus on supportive care, including oral rehydration therapy, to manage symptoms and prevent complications.
• In some cases, antibiotic therapy may be considered, but the choice of antibiotic and duration of treatment should be guided by susceptibility testing and clinical judgment.

Treatment Approach

• Supportive care with oral rehydration therapy should be the primary approach for treating EAEC, as most infections are self-limiting and resolve within 1-2 weeks.
• For moderate to severe cases, or in immunocompromised patients, antibiotic therapy may be considered, but the evidence is limited and the decision should be made on a case-by-case basis.
• Probiotics, such as Lactobacillus or Saccharomyces boulardii, may be beneficial in reducing symptom duration, but more research is needed to confirm their effectiveness.

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 Limitations of Use 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 for enteroaggregative E. coli is not explicitly mentioned in the label. However, rifaximin (XIFAXAN) is indicated for the treatment of travelers’ diarrhea caused by noninvasive strains of Escherichia coli.

• Enteroaggregative E. coli is a type of noninvasive E. coli, but the label does not directly state that XIFAXAN is effective against this specific strain.
• The recommended dose of XIFAXAN for travelers’ diarrhea is one 200 mg tablet taken orally three times a day for 3 days. However, since the label does not directly address the effectiveness of XIFAXAN against enteroaggregative E. coli, no conclusion can be drawn 2.

From the Research

Treatment Options for Enteroaggregative E. coli

• Antimicrobial treatment for EAEC infection should be individually based, with all children receiving adequate oral fluid hydration 3.
• Azithromycin and rifaximin have been shown to shorten the course of EAEC diarrhea in adults and are likely recommended for children with severe or persistent illness 3.
• Ciprofloxacin and rifaximin have been shown to significantly shorten the course of diarrhea in patients with EAEC infection, compared to placebo 4.
• Fluoroquinolones can be used to treat EAEC-infected individuals, but there is a need to examine alternative treatment protocols 5.
• However, a study found that antibiotic treatment, specifically ciprofloxacin, did not reduce the duration of diarrhea in adult Danish patients with EAEC-associated diarrhea 6.

Considerations for Treatment

• The heterogeneity of EAEC strains and differing host immune responses mean that not all EAEC infections are symptomatic, and treatment should be tailored to individual cases 4.
• The increasing level of antibiotic resistance, with 58% of EAEC strains being multidrug resistant, highlights the need to restrict antibiotic use to prevent further resistance development 6.
• A high virulence factor score and the presence of certain virulence genes, such as the enterotoxin EAST-1, may be associated with long-term diarrhea and should be considered when determining treatment 6.