Escherichia coli infection medical therapy

# Overview
Antimicrobial therapy is the mainstay of therapy for infections caused by Escherichia coli.

# Medical Therapy

## Antimicrobial therapy
- Escherichia coli
- 1. Meningitits
- Preferred regimen (1): Ceftriaxone 4 g IV q1224h
- Preferred regimen (2): Cefotaxime 812 g/day IV q46h
- Alternative regimen (1): Aztreonam 68 g/day IV q68h
- Alternative regimen (2): Gatifloxacin 400 mg/day IV q24h
- Alternative regimen (3): Moxifloxacin 400 mg/day IV q24h
- Alternative regimen (4): Meropenem 6 g/day IV q8h
- Alternative regimen (5): Trimethoprim-Sulfamethoxazole 1020 mg/kg/day IV q612h
- Alternative regimen (6): Ampicillin 12 g/day IV q4h
- 2. Uncomplicated urinary tract infection
- Preferred agents (IDSA/AUA Guidelines): TMP-SMX DS PO bid for 3 days
- Alternative regimen (1): Ciprofloxacin 250 mg PO bid
- Alternative regimen (2): Ciprofloxacin 500 mg XR qd for 3 days
- Alternative regimen (3): Levofloxacin 250 mg PO qd for 3 days.
- Alternative regimen (4): Nitrofurantoin 100 mg PO q6h
- Alternative regimen (5): Nitrofurantoin macrocrystals 100 mg PO bid for 7 days
- Alternative regimen (6): Fosfomycin 3 g sachet PO single dose
- Note: For older patients, those with comorbidities (e.g., diabetes mellitus) use 7-10 days course.
- 3. Pyelonephritis
- 3.1 Acute uncomplicated pyelonephritis
- Preferred regimen (1): Ciprofloxacin 500 mg bid PO for 5-7 days
- Preferred regimen (2): Ciprofloxacin-Erythromycin 1000 mg q24h
- Preferred regimen (3): Levofloxacin 750 mg q24h
- Preferred regimen (4): Ofloxacin 400 mg bid
- Preferred regimen (5): Moxifloxacin 400 mg q24h
- Alternative regimen (1): Amoxicillin-Clavulanic acid 875/125 mg PO q12h or 500/125 mg PO tid or 1000 /125 mg PO bid
- Alternative regimen (2): Oral Cephalosporins
- Alternative regimen (3): TMP-SMX 2 mg/kg IV q6h PO for 14 days
- 3.2 Acute pyelonephritis (Hospitalized)
- Preferred regimen (1): Ciprofloxacin 400 mg IV q12h
- Preferred regimen (2): Ampicillin and Gentamicin
- Preferred regimen (3): Piperacillin-Tazobactam 3.375 g IV q4-6h for 14 days
- Alternative regimen (1): Ticarcillin-Clavulanate 3.1 g IV q6h
- Alternative regimen (2): Ampicillin-Sulbactam 3 g IV q6h
- Alternative regimen (3): Piperacillin-Tazobactam 3.375 g IV q4-6h
- Alternative regimen (4): Ertapenem 1 g IV q24h
- Alternative regimen (5): Doripenem 500 mg q8h for 14 days
- 4. Travelers diarrhea
- 4.1 Prophylaxis
- Preferred regimen (1): Bismuth subsalicylate  two chewable tablets  qid
- Preferred regimen (2): Norfloxacin 400 mg PO qd
- Preferred regimen (3): Ciprofloxacin 500 mg PO qd
- Preferred regimen (4): Rifaximin 200 mg  PO qd or bid
- 4.2 Symptomatic treatment
- Preferred regimen (1): Bismuth subsalicylate 1 oz PO every 30 min for 8 doses
- Preferred regimen (2): Loperamide 4 mg PO then 2 mg after each loose stool not to exceed 16 mg daily
- 4.3 Antibiotic treatment
- Preferred regimen (1): Fluoroquinolones, Norfloxacin 400 mg PO bid
- Preferred regimen (2): Ciprofloxacin 500 mg PO bid
- Preferred regimen (3): Ofloxacin 200 mg PO bid
- Preferred regimen (4): Levofloxacin 500 mg PO qd
- Preferred regimen (5): Azithromycin 1000 mg PO single dose
- Preferred regimen (6): Rifaximin 200 mg PO tid
- 5. Malacoplakia
- Preferred regimen (1): Bethanechol chloride AND Ciprofloxacin 400 mg IV q12h
- Preferred regimen (2): Bethanechol chloride AND TMP-SMX 2 mg/kg (TMP component IV q6h)
- 6. Bacteremia/pneumonia
- Preferred regimen (1): Ceftriaxone 1-2 g IV q24h
- Preferred regimen (2): Ciprofloxacin 400 mg IV q12h or 500 mg PO q12h
- Preferred regimen (3): Levofloxacin 500 mg PO/IV q24h
- Preferred regimen (4): Moxifloxacin 400 mg IV/PO q24h
- Preferred regimen (5): Ampicillin 2 g IV q6h (if sensitive)
- Preferred regimen (6): TMP-SMX 5-10 mg/kg/day for q6-8h IV (if sensitive)
- Alternative regimen (1): Imipenem, Meropenem, Ertapenem, Doripenem; Ceftazidime, Cefepime; Cefazolin or Cefuroxime (if sensitive); Aztreonam; Ticarcillin, Piperacillin; Piperacillin-Tazobactam
- Alternative regimen (2): Ampicillin-sulbactam 3 g IV q6h AND (Gentamicin 1.5 mg/kg IV q8h or 5-7 mg/kg/day IV OR Tobramycin 5 mg/kg/day IV)
- Note (1): A 7- to 14-day course of antibiotic therapy is usually recommended.
- Note (2): The choice of antimicrobial agents should be based on susceptibility results.
- Note (3): Monotherapy with aminoglycosides is generally not recommended for bacteremia or pneumonia.