Treatment of travelers' diarrhea: ciprofloxacin plus loperamide compared with ciprofloxacin alone. A placebo-controlled, randomized trial.
OBJECTIVE
To compare the safety and efficacy of loperamide used in combination with ciprofloxacin or ciprofloxacin alone for the treatment of travelers' diarrhea.


METHODS
Double-blind, placebo-controlled, randomized clinical trial.


METHODS
United States Army hospital in Egypt.


METHODS
United States military personnel with travelers' diarrhea (n = 104) during a military exercise in November 1989. Persons who were noncompliant, had bloody diarrhea, or had received antidiarrheal medications before entry into the study were excluded.


METHODS
All participants with travelers' diarrhea were treated with ciprofloxacin, 500 mg twice daily for 3 days. Fifty of these patients were randomly assigned to receive loperamide, a 4-mg first dose and 2 mg for every loose stool (as much as 16 mg/d), and 54 were randomly assigned to receive placebo.


METHODS
Enterotoxigenic Escherichia coli was isolated from 57% of patients; Shigella and Salmonella, seen in 4% and 2% of patients, respectively, were not common.


RESULTS
After 24 hours, the symptoms of 82% of patients in the ciprofloxacin and loperamide group compared with 67% in the ciprofloxacin and placebo group had improved or fully recovered (odds ratio, 2.3; 95% CI, 0.8 to 6.3; P = 0.08). After 48 hours, the symptoms of 90% of both groups had improved or fully recovered. The mean number of stools for those receiving loperamide was not much lower than those who did not receive loperamide after 24 hours (1.9 +/- 0.2 [SE] compared with 2.6 +/- 0.2) or 48 hours (3.1 +/- 0.3 compared with 4.0 +/- 0.3) of treatment (P = 0.19).


CONCLUSIONS
In a region where enterotoxigenic E. coli was the predominant cause of travelers' diarrhea, loperamide combined with ciprofloxacin was not better than treatment with ciprofloxacin alone. Loperamide appeared to have some benefit in the first 24 hours of treatment in patients infected with enterotoxigenic E. coli. Both regimens were safe.
Taylor
D N
DN
Walter Reed Army Institute of Research, Washington, DC.
Sanchez
J L
JL
Candler
W
W
Thornton
S
S
McQueen
C
C
Echeverria
P
P
D002939:Ciprofloxacin / Q000627:therapeutic use*; D003967:Diarrhea / Q000188:drug therapy* / Q000382:microbiology; 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; D013223:Statistics as Topic; D014195:Travel
D002939:Ciprofloxacin; D008139:Loperamide