Treatment of traveler's diarrhea with ciprofloxacin and loperamide.
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.
Petruccelli
B P
BP
Division of Preventive Medicine, Walter Reed Army Institute of Research, Washington, DC.
Murphy
G S
GS
Sanchez
J L
JL
Walz
S
S
DeFraites
R
R
Gelnett
J
J
Haberberger
R L
RL
Echeverria
P
P
Taylor
D N
DN
D002169:Campylobacter Infections / Q000188:drug therapy; D002939:Ciprofloxacin / Q000627:therapeutic use*; D003967:Diarrhea / Q000188:drug therapy*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004405:Dysentery, Bacillary / Q000188:drug therapy; D004927:Escherichia coli Infections / Q000188:drug therapy; D006801:Humans; D008139:Loperamide / Q000627:therapeutic use*; D008889:Military Personnel; D012480:Salmonella Infections / Q000188:drug therapy; D013785:Thailand; D014195:Travel; D014481:United States
D002939:Ciprofloxacin; D008139:Loperamide