**9.2 Treatment**

Treatment of EPEC diarrhea includes oral rehydration therapy to prevent dehydration by correcting fluid and electrolyte losses. Oral rehydration may be sufficient for cases of self-limited acute diarrhea, but persistent cases of diarrhea may include parenteral rehydration, and more severe cases may require total parental nutrition and use of antimicrobials [102]. Multidrug resistance has been reported in EPEC strains from diverse parts of the world [27–29, 44, 104, 105]. Alternative therapies, employing the use of bismuth subsalicylate, specific bovine anti-EPEC milk immunoglobulins, and also zinc, have been proven useful for treatment and prevention of EPEC diarrhea [106].

### **9.3 Vaccines**

There are no currently available vaccines to prevent EPEC infection. However, a recent study has used bacterial ghosts devoid of cytoplasmic contents but expressing all EPEC surface components in vaccination challenge experiments with mice, and the results showed 84–90% protection in control mice [107]. Interestingly, protective effect of breast-feeding was shown to provide excellent protection against EPEC infection. Several investigators have shown that breast milk provides protection against EPEC O antigens and outer membrane proteins [108, 109]. Furthermore, IgA antibodies against BFP, intimin, EspA, and EspB proteins were identified in maternal colostrum and serum samples [110–118].
