Therapeutic options for diarrheagenic Escherichia coli

Abstract

Although diarrheagenic E. coli (DEC) pathotypes cause diarrhea by different mechanisms, a critical clinical sign that places a patient in a life-threatening condition is dehydration. Treatment of dehydration radically improved with the establishment of oral rehydration solutions (ORS), which significantly contributed to a decrease in diarrhea-associated childhood mortality from two million deaths per year in the 1960s to less than 0.5 million deaths per year in the present time. In this chapter, we describe DEC-associated diarrhea treatment strategies to address three main conditions: dehydration, infection, and toxin-associated illness. We describe oral versus parenteral strategies to control dehydration as well as the use of zinc and special nutritional diets for the management of diarrhea. To control infection, we review the use of systemic antibiotics for DEC-associated diarrhea and include a discussion section on the pros and cons of antibiotics use for diarrhea. Among all DECs-associated diarrhea, STEC-associated diarrhea complicated with hemolytic uremic syndrome (HUS) remains a treatment challenge. We review recent literature on attempts to inhibit the Shiga toxin to prevent or treat HUS. We end the chapter with a summary of new strategies and novel technologies in the treatment of DEC-associated diarrhea, some under development, others undergoing preclinical studies, and some being evaluated in clinical trials. We provide the latest information on antibody-based therapies and information on specific lytic bacteriophages targeting STEC as an early treatment to prevent HUS.