Traveler's Diarrhea in Thailand: Randomized, Double-Blind Trial Comparing Single-Dose and 3-Day Azithromycin-Based Regimens with a 3-Day Levofloxacin Regimen

Abstract

Single-dose azithromycin is recommended for empirical therapy of traveler's diarrhea acquired in Thailand and is a reasonable first-line option for empirical management in general.

Global Epidemiology of Campylobacter Infection

“…For example, a recent randomized double-blind trial conducted in Thailand that compared macrolide regimens (single-dose and 3-day azithromycin treatments) with a fluoroquinolone regimen (3-day levofloxacin treatment) for the empirical management of traveler's diarrhea, mainly caused by C. jejuni/C. coli (64%), reported a cure rate of 96% with azithromycin, compared to 71% with levofloxacin (281). Similarly, the rate of microbiological eradication was superior with azithromycin-based regimens (96% to 100%) compared to the levofloxacin regimen (38%) (P ϭ 0.001) (281).…”

“…coli (64%), reported a cure rate of 96% with azithromycin, compared to 71% with levofloxacin (281). Similarly, the rate of microbiological eradication was superior with azithromycin-based regimens (96% to 100%) compared to the levofloxacin regimen (38%) (P ϭ 0.001) (281). The high efficacy of azithromycin was supported by a further study comparing a single-dose azithromycin regimen to a 5-day erythromycin treatment in children with campylobacteriosis, which showed that azithromycin was significantly superior to erythromycin in eradicating the pathogen and accelerating the time to clinical cure (282).…”

Association of Mass Treatment with Azithromycin in Trachoma-Endemic Communities with Short-Term Reduced Risk of Diarrhea in Young Children

“…15 Results from several in vitro studies and small randomized controlled trials suggest that azithromycin is efficacious in the treatment of infections caused by Salmonella , Shigella , Campylobacter , and possibly E. coli . [16][17][18] However, the effect of mass prophylactic treatment with azithomycin on incident diarrheal morbidity among young children living in areas where trachoma is prevalent has not been studied. If azithromycin is found to be effective in preventing diarrheal infections and if its effect within a community persists, it may significantly reduce the burden of diarrheal illness in affected communities.…”

Immunogenicity and Protective Efficacy of Recombinant Campylobacter jejuni Flagellum-Secreted Proteins in Mice

“…Campylobacter jejuni is an important worldwide cause of bacterial diarrhea (7,10), and in some geographical regions it is the primary cause of traveler's diarrhea (31,33,38). In addition to diarrheal disease, C. jejuni infection is associated with extraintestinal complications including reactive arthritis (13,25) and Guillain-Barré syndrome (16,18).…”