Ciprofloxacin or Trimethoprim-Sulfamethoxazole as Initial Therapy for Travelers' Diarrhea

Abstract

The efficacy of ciprofloxacin was compared with that of trimethoprim-sulfamethoxazole in a placebo-controlled trial of the 5-day treatment of acute diarrhea among 181 adults recently arrived in Guadalajara, Mexico. Both antimicrobial agents were significantly (p less than 0.0001) more efficacious than placebo in the treatment of diarrhea, with the average duration of diarrhea being 29, 20, and 81 hours, respectively, in the ciprofloxacin, trimethoprim-sulfamethoxazole, and placebo treatment groups. The antimicrobial agents were also more efficacious than placebo in treating diarrhea caused by enterotoxigenic Escherichia coli, invasive enteropathogens, and unknown pathogens. Both antimicrobials were effective in treating mild-to-moderate and moderate-to-severe disease, and both were well tolerated. Ciprofloxacin appears to be a logical alternative to trimethoprim-sulfamethoxazole in the initial treatment of acute travelers' diarrhea.

Treatment of travellers' diarrhoea with fleroxacin: a case study

“…Similarly, ciprofloxacin (500 mg daily) conferred 94% protection against the onset of travellers' diarrhoea (Reves et al, 1988). However, in another study, ciprofloxacin and co-trimoxazole were equally effective as treatment for travellers' diarrhoea in American students visiting an area of Mexico where trimethoprim resistance amongst bacterial enteropathogens was low (Ericsson et al, 1987). The average durations of diarrhoea were 29, 20 and 81 h for patients given ciprofloxacin, co-trimoxazole and placebo respectively.…”

“…They are also well tolerated and have a reduced capacity for promoting the development of resistance (Ericsson et al, 1987;Scott et al, 1990). Norfloxacin, in a dosage of 400 mg daily, has been shown to be effective as shortterm prophylaxis for acute diarrhoea (Scott et al, 1990).…”

“…In both 1985 and 1992 it was recommended that antibiotic therapy should be reserved for severe, prolonged or dysenteric illnesses and that mild or moderate diarrhoea could be treated with drugs other than antibiotics, such as loperamide or bismuth subsalicylate (National Institute of Health Concensus Development Conference, 1985;Farthing et al, 1992). On the other hand, antimicrobial therapy has been shown to reduce the duration of symptoms to between 24 and 36 h (Ericsson et al, 1987) and, when combined with loperamide, to an even shorter period (Ericsson et al, 1990).…”

“…However, bacterial resistance to each of these agents has been demonstrated in various parts of the world (Farrar, 1985) and alternatives are, therefore, necessary. In clinical trials where they have been evaluated as either treatment or prophylaxis, ciprofloxacin and norfloxacin have been shown to be effective (Johnson et al, 1986;DuPont, Corrado & Sabbaj, 1987;Ericsson et al, 1987;Lolekha et al, 1988;Scott et al, 1990). Fleroxacin is a new 6,8-difluoro-4-quinolone which also exhibits a broad spectrum of antibacterial activity (Hohl, von Graevenitz & Zollinger-Iten, 1988).…”

Current Clinical Management Suggestions: Emergency Department Management of a Patient with Acute Diarrhea

“…'nın [4] yapmış olduğu çalışmada etkene bakmaksızın akut turist diyaresi olan 181 hasta çalışmaya dahil edilmiştir. Hastalar üç gruba ayrılmış ve sırasıyla beş günlük ciprofloxacin, trimetaprim-sülfametasozol ve placebo verilmiştir.…”