Ciprofloxacin and Loperamide in the Treatment of Bacillary Dysentery

Murphy, Gerald S.; Bodhidatta, Ladaporn; Echeverria, Peter; Tansuphaswadikul, Somsit; Hoge, Charles W.; Imlarp, Somchai; Tamura, Kazumichi

doi:10.7326/0003-4819-118-8-199304150-00002

Cited by 105 publications

(28 citation statements)

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“…Similar results have been demonstrated in a relatively large study in which hospitalized adult patients with bacillary dysentery ( ) were treated with ciprofloxacin n p 42 and loperamide [59]. Prolongation or worsening of disease or excretion of enteric pathogens was not seen.…”

Section: Discussionsupporting

confidence: 70%

Antimotility Agents for the Treatment ofClostridium difficileDiarrhea and Colitis

Koo

Musher

et al. 2009

CLIN INFECT DIS

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Antimotility agent use for the treatment of Clostridium difficile infection (CDI) is discouraged. We reviewed the literature and unpublished postmarketing surveillance reports regarding antimotility treatment of CDI. Twenty reports met inclusion criteria, describing 55 patients with CDI who were exposed to antimotility agents. All studies were case reports or series, with the exception of 1 retrospective review. Nineteen patients (35%) improved, with clinical resolution. Nine patients (16%) died, and 27 patients (49%) had unknown outcomes. Seventeen patients (31%) with CDI developed colonic dilation; 5 of these patients with severe CDI died. However, all patients who experienced complications or died were given antimotility agents alone initially, without an appropriate antibiotic. Twenty-three patients who received metronidazole or vancomycin coadministered with the antimotility agent experienced no complications. Evidence supporting the hypothesis that worsened outcomes are associated with antimotility therapy of CDI is lacking. Further study of the role of antimotility agents in providing symptomatic relief and reducing environmental contamination with infectious stool may be warranted.

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Section: Discussionsupporting

confidence: 70%

Antimotility Agents for the Treatment ofClostridium difficileDiarrhea and Colitis

Koo

Musher

et al. 2009

CLIN INFECT DIS

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“…16 Loperamide, the antimotility agent of choice for adults, inhibits intestinal peristalsis and has antisecretory properties, but unlike other opiates (such as codeine, diphenoxylate, and paregoric), it does not penetrate the nervous system and has no substantial potential for addiction. 17 When it is used with antibiotics for traveler's diarrhea 18 or bacillary dysentery, 19 it may reduce the duration of diarrhea by as much as one day. Because antimotility agents have been implicated in prolonged fever in human volunteers with shigellosis, 20 toxic megacolon in patients with C. difficile infection, and the hemolytic-uremic syndrome in children infected with Shiga toxin-producing E. coli, 21 these agents should be avoided in patients with bloody diarrhea or suspected inflammatory diarrhea.…”

Section: Nonspecific Symptomatic Therapymentioning

confidence: 99%

Acute Infectious Diarrhea

2004

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“…In addition, a significantly lower median number of total unformed stools was reported in the ciprofloxacin/loperamide group (2.0 versus 6.5; p=0.016). 44 Use of loperamide was also examined in a randomized, double-blind trial involving military personnel in Egypt with TD. All patients received 500 mg ciprofloxacin twice daily for three days with approximately half receiving loperamide (4 mg initially followed by 2 mg after each unformed stool; not exceeding 16 mg/day) and the other half a placebo.…”

Section: Fluoroquinolonesmentioning

confidence: 99%

Antibiotic Therapy for Acute Watery Diarrhea and Dysentery

Tribble

2017

Military Medicine

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Diarrheal disease affects a large proportion of military personnel deployed to developing countries, resulting in decreased job performance and operational readiness. Travelers’ diarrhea is self-limiting and generally resolves within five days; however, antibiotic treatment significantly reduces symptom severity and duration of illness. Presently, azithromycin is the preferred first-line antibiotic for the treatment of acute watery diarrhea (single dose 500 mg), as well as for febrile diarrhea and dysentery (single dose 1000 mg). Levofloxacin and ciprofloxacin are also options for acute watery diarrhea (single dose 500 mg and 750 mg, respectively) and febrile diarrhea/dysentery in areas with high rates of Shigella (500 mg once for three days [once daily with levofloxacin and twice daily with ciprofloxacin]), but are becoming less effective due to increasing fluoroquinolone resistance, particularly among Campylobacter spp. Another alternate for acute watery diarrhea is rifaximin (200 mg three times per day for three days); however, it should not be used with invasive illness. Use of loperamide in combination with antibiotic treatment is also beneficial as it has been shown to further reduce gastrointestinal symptoms and duration of illness. Due to regional differences in the predominance of pathogens and resistance levels, choice of antibiotic should take travel destination into consideration.

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Ciprofloxacin and Loperamide in the Treatment of Bacillary Dysentery

Abstract: Loperamide decreases the number of unformed stools and shortens the duration of diarrhea in dysentery caused by Shigella in adults treated with ciprofloxacin.

Cited by 105 publications

References 0 publications

Antimotility Agents for the Treatment ofClostridium difficileDiarrhea and Colitis

Antimotility Agents for the Treatment ofClostridium difficileDiarrhea and Colitis

Acute Infectious Diarrhea

Antibiotic Therapy for Acute Watery Diarrhea and Dysentery

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