Treatment of Travelers' Diarrhea with Trimethoprim/Sulfamethoxazole and with Trimethoprim Alone

Abstract

We conducted a double-blind treatment study of 110 adults from the United States who were attending summer classes in Guadalajara, Mexico, and had diarrhea (four or more unformed stools in 24 hours, or three or more unformed stools per eight-hour period plus one or more additional clinical indicators of enteric infection). Thirty-seven patients received trimethoprim/sulfamethoxazole (TMP/SMX) (160 mg of TMP and 800 mg of SMX), 38 were given TMP alone (200 mg), and 35 took a placebo twice daily for five days. By the end of the first 24 hours of treatment, patients taking either TMP/SMX or TMP alone passed fewer unformed stools than did patients given placebo (P = 0.0002 and P = 0.01, respectively). Abdominal pain and nausea were reduced in both treatment groups. The beneficial effect was seen in treatment of Escherichia coli-induced diarrhea, shigellosis, and diarrhea not associated with an enteropathogen. Five per cent of patients given TMP/SMX, 8 per cent of those given TMP, and 49 per cent of those given placebo were considered treatment failures (P less than 0.001 for both active drugs as compared with placebo). Early treatment with TMP/SMX or TMP is an alternative to prophylactic use of drugs for travelers' diarrhea.

Isolation of enterotoxigenicEscherichia colifrom British troops in Saudi Arabia

“…In the present study, an ETEC strain was isolated by DNA probing in 26 % of the diarrhoea cases examined, a value that falls at the lower end of the range of the estimated occurrence of ETEC in other reports [1][2][3][4]. The period of study coincided with the colder winter months in Saudi Arabia, conditions in which ETEC infection might be expected to be less prevalent.…”

“…Strains of enterotoxigenic Escherichia coli (ETEC) are the most common cause of travellers' diarrhoea [1]. Studies that have examined the association of ETEC and diarrhoea in troops, students and Peace Corps volunteers in tropical areas have found ETEC in between 29 and 75 % of diarrhoea cases [2][3][4]. Strains of ETEC are also of major importance in diarrhoeal disease affecting young children in developing countries and contribute significantly to the mortality of this group [51.…”

Antimicrobial resistance of Shigella isolates causing traveler's diarrhea

“…The high prevalence of resistance to ampicillin made trimethoprim-sulfamethoxazole the drug of choice. Although trimethoprim has been recommended for the therapy of shigellosis (6,21), its use should be reconsidered in view of the high frequency of resistance to trimethoprim-sulfamethoxazole in isolates from travelers returning from all regions documented. Of S. sonnei isolates from patients with traveler's diarrhea, 73 and 54% showed tetracycline and trimethoprimsulfamethoxazole resistance, respectively, compared with only 8% of isolates from nontravelers (P < 0.007 and P < 0.0002).…”

Prevention and self-treatment of travelers' diarrhea

“…Early studies using either doxycycline (138,142) or trimethoprim-sulfamethoxazole (TMP-SMX) (37) showed that they were effective in preventing traveler's diarrhea in many parts of the world; however, widespread resistance to both of these agents has subsequently developed (79), thus limiting their usefulness.…”

“…Antimicrobials reduce the duration of diarrhea from 50 to 95 h if untreated to 16 to 30 h, as well as reducing related symptoms such as abdominal cramping and time spent incapacitated (27,34,40).…”