Five versus three days of ofloxacin therapy for traveler's diarrhea: a placebo-controlled study

DuPont, Herbert L.; Ericsson, C. D.; Mathewson, John J.; DuPont, Margaret W.

doi:10.1128/aac.36.1.87

Cited by 83 publications

(24 citation statements)

References 18 publications

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“…Chloramphenicol presented good activity against ETEC, but quinolones such as nalidixic acid or ciprofloxacin and amoxicillin plus clavulanic acid showed the best activity against these microorganisms. In the last decade, fluoroquinolones have been shown to be highly effective in reducing the duration of traveler's diarrhea (3,5,14,18). However, 5 (6%) of the 82 ETEC strains investigated in our study were resistant to nalidixic acid, and one of them was also resistant to ciprofloxacin (MIC of 32 g/ml).…”

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confidence: 62%

Quinolone Resistance in Enterotoxigenic Escherichia coli Causing Diarrhea in Travelers to India in Comparison with Other Geographical Areas

Vila¹,

Vargas²,

Ruiz³

et al. 2000

Antimicrob Agents Chemother

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Enterotoxigenic Escherichia coli isolates were identified as a cause of traveler's diarrhea in 82 of 520 (16%) patients and tested for resistance to seven antimicrobial agents. Thirty patients (36%) needed antimicrobial therapy: 17 (56%) for persistence of symptoms and 13 (44%) for severity of symptoms. Ampicillin, tetracycline, and trimethoprim-sulfamethoxazole resistance was high. Chloramphenicol showed moderate activity, and amoxicillin plus clavulanic acid, nalidixic acid, and ciprofloxacin showed very good activity. Five nalidixic acid-resistant strains were isolated, four from patients visiting India.Enterotoxigenic Escherichia coli (ETEC) is the major cause of traveler's diarrhea in people from industrialized countries visiting less-developed countries (6, 7) and is an important cause of dehydrating diarrhea in infants and children in lessdeveloped countries (13). Traveler's diarrhea caused by ETEC strains is usually a mild, self-limited disease, but for severe traveler's diarrhea, early treatment with loperamide and an antibiotic such as trimethoprim-sulfamethoxazole, doxycycline, or a fluoroquinolone has been recommended (4).Many previous studies of antimicrobial susceptibility of ETEC involved a small number of isolates from a single geographic location. We, therefore, performed antimicrobial susceptibility testing of ETEC isolates causing traveler's diarrhea originating from diverse geographical locations. Investigation of the mechanisms of acquisition of quinolone resistance in the nalidixic acid-resistant ETEC strains was also performed.During the period from 1994 to 1997, stool specimens from 520 adult patients with traveler's diarrhea were analyzed. The patients were recruited from the traveler's clinic of the Tropical Medicine Department of the Hospital Clinic. All patients had diarrhea on arrival in Spain or within 2 days after their return. The stool specimens were cultured for E. coli and other bacterial enteropathogens by conventional methods (11). Single-colony subcultures of all different lactose-fermenting colonial morphotypes growing on MacConkey agar were identified by conventional criteria. The E. coli isolates were tested by PCR to detect the heat-stable (ST) and heat-labile (LT) toxin genes (15). ETEC strains were isolated from 82 patients (16%) with traveler's diarrhea. The distribution of these strains according to the type of enterotoxin synthesized was as follows: 58 strains (71%) produced the ST, 11 strains (13%) produced LT, and 13 strains (16%) produced both toxins (LT/ST). ETEC strains were isolated from stool samples of patients traveling to different tropical and subtropical areas, except for Central and South Africa. The range of prevalence was from 7.5% to 31%, with West Africa and the Indian Subcontinent being the two geographic areas where ETEC strains were more prevalent, at 31 and 22%, respectively. Thirty patients (36%) needed antimicrobial therapy: 17 patients (56%) because of persistence of symptoms and 13 (44%) because of severity of symptoms. In 14 treated patient...

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Quinolone Resistance in Enterotoxigenic Escherichia coli Causing Diarrhea in Travelers to India in Comparison with Other Geographical Areas

Vila¹,

Vargas²,

Ruiz³

et al. 2000

Antimicrob Agents Chemother

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“…However, 20 to 40% of subjects remain without a definable cause (5,6), and antibiotics shorten TD illness without an identified pathogen (2)(3)(4), suggesting the presence of occult bacterial enteropathogens.…”

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Microbial Etiology of Travelers' Diarrhea in Mexico, Guatemala, and India: Importance of Enterotoxigenic Bacteroides fragilis and Arcobacter Species

Jiang¹,

DuPont

Brown³

et al. 2010

J Clin Microbiol

111

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“…Prophylaxis with bismuth subsalicylate tablets confers at best 65% protection (3,13). Treatments for traveler's diarrhea include fluid replacement; symptomatic relief with agents such as bismuth subsalicylate, adsorbents, and antimotility agents; and the use of antimicrobial agents as single doses or for as long as 5 days (4)(5)(6)(7).…”

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Optimal dosing of trimethoprim-sulfamethoxazole when used with loperamide to treat traveler's diarrhea

Ericsson¹,

Nicholls-Vasquez²,

DuPont³

et al. 1992

Antimicrob Agents Chemother

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To explore the optimal dosing regimen for trimethoprim-sulfamethoxazole (TMP-SMX) when used in combination with loperamide to treat traveler's diarrhea, 190 U.S. adults with acute diarrhea were enrolled in a double-blind, randomized trial in Guadalajara, Mexico. All patients received loperamide (4-mg loading dose; 2 mg after each loose stool, not to exceed 16 mg/day for 3 days) and were randomized to receive a 3-day course of TMP-SMX (160:800 mg twice daily for six doses) (group A), a single large dose of TMP-SMX (320:1,600 mg) (group B), or a large loading dose (320:1,600 mg) followed by standard doses for 3 days (160:800 mg twice daily for five doses) (group C). Patients in group C responded best (P < 0.01), with 75% of subjects recovered from diarrhea in 12 h compared with 34 h (group A) and 33 h (group B). Similar differences in favor of group C were noted in the subset of patients who presented with moderate to severe diarrhea. On average, patients in group C took significantly (P < 0.05) less loperamide (1.2 mg) after the 4-mg loading dose compared with patients in group A (2.4 mg) or group B (2.0 mg). We conclude that the most efficacious treatment of traveler's diarrhea in the interior of Mexico is to take loperamide in usual doses to control symptoms in combination with a single large dose of TMP-SMX, which should then be continued for 3 days in standard doses.

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Five versus three days of ofloxacin therapy for traveler's diarrhea: a placebo-controlled study

Abstract: In this double-blind study with 232 patients, 300 mg of ofloxacin given orally twice daily for 5 or 3 days was compared with placebo for the treatment of acute diarrhea in U.S. students visiting Guadalajara, Mexico.

Cited by 83 publications

References 18 publications

Quinolone Resistance in Enterotoxigenic Escherichia coli Causing Diarrhea in Travelers to India in Comparison with Other Geographical Areas

Quinolone Resistance in Enterotoxigenic Escherichia coli Causing Diarrhea in Travelers to India in Comparison with Other Geographical Areas

Microbial Etiology of Travelers' Diarrhea in Mexico, Guatemala, and India: Importance of Enterotoxigenic Bacteroides fragilis and Arcobacter Species

Optimal dosing of trimethoprim-sulfamethoxazole when used with loperamide to treat traveler's diarrhea

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