Escherichia coli

Escherichia coli, E. coli, Enterotoxigenic E. coli, ETEC, Enteroinvasive E. coli, EIEC, Enteroadherent E. coli, EAEC

Enterotoxigenic E. coli (ETEC)
1. Most common pathogen in Traveler's Diarrhea
Enteroinvasive E. coli (EIEC)
1. Causes acute Dysentery-like Diarrhea
Enteroadherent E. coli (EAEC)
1. Causes Diarrhea in infants
Enterohemorrhagic E. coli (EHEC)
1. See Enterohemorrhagic E. coli (EHEC)
2. Bloody Diarrhea
3. Includes a subset of Shiga Toxin-producing E. coli (e.g. 0157:H7)
4. Rapid onset in 12-72 hours

Some strains release Shiga-like toxin (e.g. 0157:H7)
1. See Enterohemorrhagic E. coli (EHEC)
Certain E. coli strains have unique adherent ability
1. E. coli 0157:H7
2. E. coli various serotypes (over 200)

See Acute Diarrhea
See Traveler's Diarrhea
Supportive Care
1. Oral Rehydration
2. Avoid anti-motility (e.g. Imodium may worsen disease)
Antibiotics
1. Indications
  1. Severe cases
2. Contraindications
  1. Enterohemorrhagic E. coli (EHEC, E. coli 0157:H7)
    1. Risk of Hemolytic Uremic Syndrome
3. Disadvantages of Antibiotics
  1. Antibiotics do not alter disease course
  2. May increase Hemolytic Uremic Syndrome risk
4. Course
  1. Enterotoxigenic E. coli: Treat for 3 days
  2. Enteroinvasive E. coli: Treat for 5 days
5. Adults - first line
  1. Ciprofloxacin 500 mg twice daily for 3 days
6. Adults - second line
  1. Trimethoprim-Sulfamethoxazole (Bactrim) 160/800 mg twice daily for 3 days
  2. Azithromycin 500 mg daily for 3 days (ETEC only)
7. Children
  1. Trimethoprim-Sulfamethoxazole (Bactrim) 10 mg Trimethoprim/kg/day orally divided twice daily for 3 days
  2. Azithromycin (ETEC only)