Medication
Depending on the type of E. coli infection you have, appropriate medications can vary. Some infections may resolve on their own. Antibiotics may be prescribed for some but can cause complications for others.
Urinary Tract Infections
A urinary tract infection (UTI) can happen when some strains of E. coli enter the urinary system. This is the most common infection caused by E. coli.
Doctors typically treat UTIs with a range of antibiotics, says Mahesh Polavarapu, MD, the medical director of emergency medicine at NewYork-Presbyterian Westchester in New York. Which antibiotic they prescribe depends on the type of infection and patient characteristics, he says.
UTIs are classified as uncomplicated if they are mild and happen in otherwise healthy women. These are typically treated with oral antibiotics for a short period of time, Dr. Polavarapu says. The infection is classified as complicated if it shows up in males, children, pregnant people, and people with a weakened immune system.
“Complicated UTIs are treated for a longer period of time and may require IV antibiotics,” Polavarapu says.
Some antibiotics used to treat uncomplicated E. coli–associated UTIs include:
- sulfamethoxazole and trimethoprim (Bactrim, Bactrim DS)
- fosfomycin (Monurol)
- nitrofurantoin (Furadantin, Macrobid, Macrodantin)
- cephalexin (Biocef, Daxbia, Keflex, Keftab)
A one- to three-day course of antibiotics can successfully treat most UTIs, with symptoms subsiding after a few doses.
Some strains of E. coli, called extended-spectrum beta-lactamase (ESBL) E. coli, are resistant to many antibiotic treatments.
In these cases, or those coupled with a kidney infection, your doctor may prescribe a fluoroquinolone. Medications in this class include:
- ciprofloxacin (Cipro)
- levofloxacin (Levaquin)
Ask your doctor about the potential side effects of fluoroquinolones. “The one that we ensure patients are aware of is the risk of tendinopathy, or tendon pain or reduced function without rupture, and tendon rupture,” Polavarapu says. “The more common side effects are gastrointestinal, like nausea, vomiting, diarrhea, and dyspepsia [indigestion].”
In severe UTI cases, you may be prescribed:
- ceftriaxone (Ceftrisol Plus, Rocephin)
- piperacillin-tazobactam (Zosyn)
- carbapenems
E. coli–Related Traveler’s Diarrhea
Traveler’s diarrhea often happens when a person visits another country and is exposed to bacteria (most often a strain of E. coli called enterotoxigenic E. coli, or ETEC) through food or water with which their body is not familiar.
In addition to hydration, treatment may include antidiarrheal drugs such as loperamide (Imodium). This medication is not recommended for people who have a fever, have bloody stools, or are age 18 or younger.
A healthcare professional may prescribe antibiotics if you have three or more loose stools in an eight-hour period or severe symptoms, including fever, dehydration, or blood or mucus in the stools. Medications may include:
- ciprofloxacin (Cipro)
- levofloxacin (Levaquin)
- azithromycin (Zithromax, Zmax)
- rifaximin (Xifaxan)
Intestinal E. coli Infections
Some intestinal E. coli infections, such as those caused by Shiga toxin–producing E. coli, or STEC, do not require medication. Treating these cases with antibiotics may increase your risk of developing hemolytic uremic syndrome (HUS), a condition that damages the kidneys and can cause blood clots.
It’s also important not to treat STEC infections with over-the-counter antidiarrheal medication, which also can increase your risk of developing HUS.
Antidiarrheal medication slows down the digestive system and may keep toxins in your body.
If you have a STEC infection, your doctor will monitor your symptoms. It’s important to drink fluids to prevent dehydration.
Hemolytic Uremic Syndrome
When HUS occurs, toxins destroy red blood cells, disrupting the kidneys’ filtering system, which can cause kidney failure.
HUS affects up to 22 percent of people with diarrhea from an E. coli infection, primarily children ages 5 and younger and adults ages 60 or older.
HUS requires prompt medical treatment, which may include fluid replacement, blood or platelet transfusion, and kidney dialysis.
Most people with HUS who receive appropriate, timely treatment recover fully, especially children. Some do have lasting kidney damage.
In such cases, a healthcare professional may recommend medication to lower blood pressure and help prevent kidney damage.
When there are complications, HUS may be treated with a medication called eculizumab (Soliris). This helps prevent further blood vessel damage, but it requires a vaccination to prevent meningitis, a potential side effect.
Neonatal Meningitis
E. coli is the second-leading cause of neonatal bacterial meningitis, behind group B streptococcus (GBS). Neonatal bacterial meningitis occurs in just 3 out of every 10,000 full-term pregnancies. It does require treatment, with a death rate of 5 to 20 percent after treatment.
If neonatal meningitis is suspected, a healthcare professional will draw blood and perform a spinal tap (also called a lumbar puncture) to test spinal fluid for E. coli bacteria. If bacterial meningitis is confirmed, treatment includes fluids, rest, and antibiotics.
Medication may include:
- ampicillin (Principen)
- cefotaxime (Claforan)
- gentamicin (Garamycin)
Other Conditions
E. coli may result in other infections that require treatment with medication. These include:
- Bloodstream Infections These may happen when E. coli enters the bloodstream. In addition to IV therapy, medication to treat these infections may include cefepime and carbapenem.
- Sepsis An E. coli infection can progress to this extreme bodily response, especially for people with chronic health conditions or those younger than 1 or age 65 or older. It requires immediate medical attention, which can include antibiotics, in addition to oxygen and IV fluids.
- Abdominal Infections E. coli Infections These are a leading cause of peritonitis, the inflammation of the abdominal cavity. Medications used to treat these include ampicillin (Principen), cefotaxime (Claforan), ceftriaxone (Rocephin), and ertapenem (Invanz).
- Prostate Infections Bacterial prostatitis, or an inflamed prostate, can be treated with antibiotics. Typical duration of antibiotic treatment is four to six weeks.
- Pelvic Inflammatory Disease (PID) PID is most common among women younger than 35 and is often a complication of a sexually transmitted infection (STI). But E. coli infection can also cause PID. It typically is treated with antibiotics.
