Treatment of Traveler's Diarrhea with Ciprofloxacin and Loperamide

Abstract

To determine the efficacy of loperamide given with long- and short-course quinolone therapy for treating traveler's diarrhea, 142 US military personnel were randomized to receive a single 750-mg dose of ciprofloxacin with placebo, 750 mg of ciprofloxacin with loperamide, or a 3-day course of 500 mg of ciprofloxacin twice daily with loperamide. Culture of pretreatment stool specimens revealed campylobacters (41%), salmonellae (18%), enterotoxigenic Escherichia coli (ETEC, 6%), and shigellae (4%). Of the participants, 87% completely recovered within 72 h of entry. Total duration of illness did not differ significantly among the three treatment groups, but patients in the 3-day ciprofloxacin plus loperamide group reported a lower cumulative number of liquid bowel movements at 48 and 72 h after enrollment compared with patients in the single-dose ciprofloxacin plus placebo group (1.8 vs. 3.6, P = .01; 2.0 vs. 3.9, P = .01). While not delivering a remarkable therapeutic advantage, loperamide appears to be safe for treatment of non-ETEC causes of traveler's diarrhea. Two of 54 patients with Campylobacter enteritis had a clinical relapse after treatment that was associated with development of ciprofloxacin resistance.

Pre-exposure anti-Campylobacter jejuni immunoglobulin a levels associated with reduced risk of Campylobacter diarrhea in adults traveling to Thailand.

“…[10][11][12] Additionally, the clinical data obtained from patients with diarrhea are in agreement with the findings of Mattila 24 that, like Shigella infections, C. jejuni-C. coli infections are associated with a more severe form of travelers' diarrhea than is caused by other enteropathogens. The serological examination of pre-and postexposure blood samples from study volunteers shows that pretravel anti-Campylobacter IgA titers Ն 450 in healthy adults are strongly associated with reduced risk of contracting Campylobacter diarrhea while visiting Thailand.…”

“…10,11 This exercise involves members of all 4 U.S. military services, lasts ϳ 1 month, and may involve as many as 5,000 U.S. participants at its most active stage. Participants in the annual exercise have consistently experienced relatively high diarrhea attack rates, and although enterotoxigenic Escherichia coli (ETEC) is generally accepted to be the leading cause of travelers' diarrhea worldwide, Campylobacter species have been the leading cause of diarrhea among military travelers to Thailand.…”

“…In studies conducted in 1990, 1993, and 1994, C. jejuni or C. coli were detected in 41, 58, and 52%, respectively of stool samples obtained from military personnel contracting diarrhea while deployed to Thailand. [10][11][12] The high risk of people visiting Thailand acquiring a Campylobacter infection reflects the fact that it is hyperendemic among the local pediatric population. 13 In their report on diarrhea among children in Thailand, Taylor and others 14 found an inverse correlation between rising serum antibody (immunoglobulin [Ig] G, IgM, and IgA) and falling rates of infection.…”

Treatment of travellers' diarrhoea with fleroxacin: a case study

“…These results were similar to those of a previous study in which 74% of norfloxacin-treated patients were cured by 72 h compared with 38% in the placebo group (Wistrom et al, 1989). Time until production of the last unformed stool was shorter than that reported in a study of a different patient population in which ciprofloxacin was used (Petrucelli et al, 1992). In the present study, pathogens were not isolated from 47-7% of patients; this was higher than previously reported rates where the faeces of 20-40% of patients with travellers' diarrhoea failed to yield an enteric pathogen (Sack, 1990).…”

“…Treatment was limited to one or two days because previous studies had shown excellent results after equally short periods (Ericsson et al, 1990;Petrucelli et al, 1992) and because self-treatment should be limited to 48 h (Farthing et al, 1992). A control group was considered justifiable on the grounds that travellers' diarrhoea is selflimiting; its inclusion also enabled a more reliable assessment of the safety profile of fleroxacin.…”