E. Coli Treatment and Prevention

Not all E. coli infections impact the body in the same way, so not all E. coli infections are treated the same way. Here are the most common — and effective — strategies for treating (and preventing) various E. coli–related illnesses.

How to Treat Intestinal E. Coli Infections

For intestinal E. coli infections, what a person doesn’t do to treat symptoms is as important as what that person does do. For instance, intestinal E. coli infections caused by Shiga toxin–producing E. coli, or STEC — which spurs an estimated 265,000 foodborne infections each year in the United States — does not require antibiotic treatment. (1)

In fact, treating these cases with antibiotics can triple your risk of developing hemolytic uremic syndrome (HUS), a complication in which toxins destroy red blood cells, disrupting the kidneys’ filtering system and possibly causing kidney failure, according to a report published in the journal Toxins. (2)

It’s also important not to treat STEC infections with over-the-counter antidiarrheal medication. These, too, can increase your risk of developing HUS, according to a study published in Clinical Infectious Diseases. (3) Antidiarrheal medication slows down the digestive system, which prevents the body from getting rid of the toxins swiftly. (4)

But that doesn’t mean there’s nothing a person can do to help ease symptoms and feel better. Experts recommend the following supportive therapies that can be done at home to aid recovery from a STEC infection:

• Get plenty of rest. Give your body a break so it can do its best fending off the infection.
  
• Stay hydrated. Drinking plenty of clear liquids, including water and broths, can help stave off dehydration and fatigue.
• Take small sips. This can help prevent vomiting.
• Avoid foods that worsen symptoms. These include apple and pear juices, caffeine, alcohol, spicy food, dairy, fatty foods, and high-fiber foods.
• Gradually add bland food into your diet. Start with items like soda crackers, toast, eggs, and rice. (4)
  

Most healthy adults can completely recover from a STEC infection after about a week without any medical attention. But if an individual has diarrhea that has lasted for more than three days along with a high fever, bloody stools, or intense vomiting that leads to dehydration, it’s important to contact a medical professional. (5)

Treating Hemolytic Uremic Syndrome (HUS)

About 5 to 15 percent of STEC infections lead to the potentially life-threatening complication called hemolytic uremic syndrome (HUS). With HUS, the destruction of red blood cells leads to kidney failure, which then causes toxic substances to accumulate in the blood (a complication called uremia). Young children, the elderly, individuals with compromised immune systems, and those on antibiotics to treat their E. coli infection are most at risk. (6)

In general, HUS develops about one week after symptoms first appear — and once diarrhea has started to clear. Those who have HUS will initially experience symptoms similar to an E.coli intestinal infection, including vomiting, fatigue, and bloody diarrhea. (6)

Left untreated, HUS can cause numerous symptoms, such as bruising, pale skin, and jaundice. Other signs of HUS include decreased urination and, sometimes, seizures. (7)

HUS requires prompt medical treatment. This may include:

• Fluid Replacement Lost fluid and electrolytes must be carefully replaced intravenously (IV).
• Blood Transfusion IV red blood cell transfusions help reverse symptoms such as fatigue and shortness of breath.
• Platelet Transfusion If an individual is bleeding, IV platelet transfusions can help blood clot normally.
• Plasma Exchange (Plasmapheresis) Here, plasma is cleared from the blood and then replaced with donor plasma.
• Kidney Dialysis This is used to temporarily take over the kidneys’ job of filtering waste and extra fluid from the body. (7)

Most people with HUS who receive appropriate treatment in a timely manner experience a full recovery, especially children. Still, some do have lasting kidney damage. If that occurs, a healthcare professional may recommend, among other follow-up treatments, medication to lower blood pressure and help mitigate further kidney damage. (7)

Preventing Intestinal E. Coli Infection and Its Complications

While preventive measures are the same for everyone, know that pregnant women, newborns, children, the elderly, and individuals who have a compromised immune system have a higher risk of contracting a foodborne E. coli illness. To help reduce your risk, thoroughly wash hands with soapy water in these situations:

• After using the bathroom
• After changing a diaper
• Before and after preparing food or bottles
• Before and after eating
• Before touching a baby or toddler’s mouth, pacifier, or anything that goes into a child’s mouth
• After any contact with animals or their environments (like fences and pens), including at farms, petting zoos, and fairs (8)

While opting for a hand sanitizer may seem like a smart choice when no running water is close by, know that the U.S. Food and Drug Administration (FDA) has not approved any products claiming to prevent E. coli infection, though a study shows sanitizer does kill some (but not necessarily all) MRSA germs.

It’s also very important to follow certain food preparation and cooking rules. Here is what the Centers for Disease Control and Prevention urges people to do:

• Wash produce. Wash well under running water. Be sure to open up leafy greens, since E. coli can hide in the crevices.
• Cook beef thoroughly. Cook to an internal temperature of at least 145 degrees F for beef steak and roasts and at least 160 degrees F for ground beef and pork. (Steaks and roasts should rest for three minutes after coming off the grill or stove.)
• Avoid cross-contamination. Use separate cutting boards for meats and produce, and clean counters and utensils after contact with raw meat.

Finally, do not consume any unpasteurized dairy products, unpasteurized juices, or raw milk. And avoid swallowing water when swimming in lakes, ponds, streams, swimming pools, and even backyard kiddie pools. (8)

Treating E. Coli–Related Traveler’s Diarrhea

While STEC-associated diarrhea should not be treated with antibiotics nor antidiarrheals, that’s not always the case for traveler’s diarrhea. Usually, traveler’s diarrhea occurs when an individual ventures to a developing country and is then exposed to bacteria (most often a strain of E. coli dubbed enterotoxigenic E. coli, or ETEC) via food or water to which their body has little to no familiarity. (10)

Here are some treatment options for those who develop symptoms such as nausea, cramping, and diarrhea while traveling abroad:

• Stay hydrated. Consume plenty of fluids.
• Take antidiarrheal drugs. Use medication such as loperamide (Imodium), though people who have a fever or bloody stools should not take these, nor should children younger than 2 years.
• Ask if you need antibiotics. These may be prescribed by a healthcare professional if an individual experiences three or more loose stools over an eight-hour period — or severe symptoms, including fever or blood or mucus in the stools (10,11)

Preventing E. Coli–Related Traveler’s Diarrhea

Many areas of Central and South America, Mexico, Africa, the Middle East, and most of Asia are considered high-risk destinations for traveler’s diarrhea. (There is some risk when traveling to Eastern Europe and a few Caribbean islands as well.) That, of course, doesn’t mean travel to those areas should be avoided. Instead, take certain precautions when going abroad. These include avoiding:

• Food from street vendors
• Moist foods that are at room temperature, such as sauces
• Unpasteurized dairy products
• Raw or undercooked meat, fish, and shellfish
• Salads and unpeelable fruits, such as grapes and berries
• Beverages that contain ice cubes (12)

While the above tips are good for all, know that certain groups of people are more prone to developing traveler’s diarrhea. That includes people with diabetes, inflammatory bowel disease, cirrhosis of the liver, kidney disease, heart disease, or a weakened immune system. Individuals on acid blockers or antacids are also at an increased risk because the reduction in stomach acid can make it easier for bacteria such as E. coli to survive. (12)

Treating Urinary Tract Infections

Some strains of E. coli are a normal part of microbial communities in the gut, but can cause a urinary tract infection (UTI) if they make their way into the urinary system.

Doctors typically treat UTIs with a wide range of antibiotics. Which specific antibiotic is prescribed depends on the type of bacteria detected in the urine. Some antibiotics used to treat E. coli–associated UTIs include: ( 13)

• sulfamethoxazole and trimethoprim (Bactrim)
• fosfomycin (Monurol)
• nitrofurantoin (Macrobid)
• cephalexin (Keflex)

For most people, a three- or five-day course of antibiotics can successfully treat most UTIs, with pain and the persistent urge to urinate subsiding after a few doses. (15)

Some strains of E. coli, called extended-spectrum beta-lactamase (ESBL) E. coli, are resistant to many antibiotic treatments. Individuals who are most at risk include those with urinary catheters, a history of recurrent UTIs, or recent antibiotic use. (16) For these people, the following is often recommended:

• Carbapenems This classification of antibiotics includes imipenem (Primaxin IV), meropenem (Merrem), doripenem (Doribax), and ertapenem (Invanz).
• Other Antibiotics Nitrofurantoin, fosfomycin, and cefepime (Maxipeme) are sometimes a viable treatment option. (17)

Preventing Urinary Tract Infections

There are numerous ways in which one can help prevent UTIs from occurring. Some at-home measures include:

• Urinate frequently. Emptying the bladder roughly every two to three hours will help to flush the E. coli bacteria from the urinary tract before an infection can begin. (The longer urine is held in the bladder, the more likely bacteria will multiply.)
• Wipe from front to back. This helps prevent spreading bacteria from the anal area to the urethra.
• Urinate after intercourse. Sexual intercourse and contact can introduce bacteria from the anus into the bladder by way of the urethra. But urinating after sex helps to flush bacteria from your system.
• Consume plenty of liquids. Drinking water (especially after intercourse) helps dilute urine and spur more frequent urination, which flushes E. coli from the urinary tract.
• Avoid diaphragms or spermicides. These can contribute to bacterial growth and kill the good bacteria that work to protects against UTIs. (18)
• Talk to your doctor about D-mannose. This supplement may help with the prevention and treatment of UTIs, though research is limited. Studies are ongoing, however, so there may be more reliable data soon.

Treating E. Coli Infections That Cause Neonatal Meningitis

While it’s true that E. coli causes about 20 percent of all neonatal meningitis cases, bacterial meningitis is still considered very rare in developed countries thanks to the success of vaccines.

If neonatal meningitis is suspected, a healthcare professional will draw blood and perform a spinal tap (also called a lumbar puncture) in order to test spinal fluid for the E. coli bacteria. If bacterial meningitis is confirmed, treatment would consist of IV antibiotics and fluids.

With early diagnosis and proper treatment, a child with bacterial meningitis has a reasonable chance of a good recovery. (19)

Additional reporting by Joseph Bennington-Castro.

1. Food Safety and Inspection Service
2. Centers for Disease Control and Prevention
3. Nemours KidsHealth
4. Mayo Clinic