Prevention of Travelers' Diarrhea by Nonantibiotic Drugs

Steffen, Robert; Heusser, Rolf; DuPont, Herbert L.

doi:10.1093/clinids/8.supplement_2.s151

Cited by 25 publications

(7 citation statements)

References 27 publications

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“…Chemoprophylaxis with antimicrobial agents is controversial (2,9). 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).…”

mentioning

confidence: 99%

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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confidence: 99%

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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“…Apparently, other researchers in this field have had simi- lar experiences. If the dosage and duration of treatment as prescribed by the manufacturer is not exceeded, BSS seems to be a safe agent [10]. Similarly, loperamide is well tolerated, but two studies indicated that in dysenteric cases illness may be slightly aggravated [11,12].…”

Section: Discussionmentioning

confidence: 99%

Worldwide Efficacy of Bismuth Subsalicylate in the Treatment of Travelers' Diarrhea

Steffen

1990

Clinical Infectious Diseases

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“…Nonantibiotic antidiarrheal drugs, although extensively tested, have not proved to be effective with the exception of Bismuth Subsalicylate (BSS) (6,11,14). This drug significantly reduced the duration of diarrheal illness, but it is not generally available and adverse reactions cannot be excluded (23).…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Only BSS exhibited a clear and reproducible reduction of attack rates when administered prophylactically (7,23). Preparations of lactobacilli, ethacridine and the obsolete hydroxyquinolines have not demonstrated prophylactic usefulness (23). Recently, a preparation of viable Saccharomyces cerevisiae (strain HANSEN CBS 5926) was tested for its prophylactic value and produced a considerable reduction of attack rates in Austrian travellers, although it has to be conceded that BSS was, on the average, more effective (16).…”

Section: Discussionmentioning

confidence: 99%

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Traveller's diarrhea among Austrian tourists to warm climate countries: II. Clinical features

Kollaritsch

1989

Eur J Epidemiol

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The syndrome "Traveller's Diarrhea" (TD) is important for tourists travelling to warm-climate countries. In this study a worldwide survey on the clinical features of enteritis among 1,455 Austrian tourists is reported. The clinical parameters of TD show that this disease exhibits a very uniform clinical course which is not influenced by different regions with considerable differences in aetiology or by travel-associated parameters such as accommodation, travel style and individual dietary hygiene: TD starts mainly at the end of first week of the stay and the average duration of illness is 3.6 +/- 2.7 days. Watery and mucous stools were reported by 99% of patients with a frequency of 4 bowel movements per day, while bloody diarrhea occurred very rarely. However, 57.2% of patients suffered from abdominal cramps, less than one third of patients reported nausea and/or vomiting and fever accompanied the acute disease in 13%. Symptoms indicate that TD should not be considered a severe disease. The diarrheal illness will show the characteristics of an enteroinvasive disease only in rare cases. Treatment of TD is discussed: symptomatic or other non-antibiotic agents are preferable as antibiotics will only occasionally be necessary for treatment of an illness with a self-limiting character. For prophylaxis of TD, the preferable way to resolve the problem of TD in international travel, very few effective preparations are currently available, emphasizing the need for extensive research in this field.

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Prevention of Travelers' Diarrhea by Nonantibiotic Drugs

Cited by 25 publications

References 27 publications

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

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

Worldwide Efficacy of Bismuth Subsalicylate in the Treatment of Travelers' Diarrhea

Traveller's diarrhea among Austrian tourists to warm climate countries: II. Clinical features

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