title: Role of a novel antidiarrheal agent, BW942C, alone or in combination with trimethoprim-sulfamethoxazole in the treatment of traveler's diarrhea.
abstract: The efficacy of BW942C, a novel enkephalinlike pentapeptide antidiarrheal agent, was compared with the efficacy of trimethoprim-sulfamethoxazole (TMP-SMX) and the combination of the two agents in a placebo-controlled trial of the 72-h treatment of acute diarrhea. Subjects with diarrhea but without bloody stools or fever greater than 102 degrees F (38.9 degrees C) were enrolled. Administered to 134 U.S. adults with diarrhea that developed shortly after their arrival in Guadalajara, Mexico, BW942C was more efficacious than TMP-SMX in relieving diarrhea and cramps in the first 12 h of therapy, especially among subjects with diarrhea caused by enterotoxigenic E. coli. In the BW942C treatment group, 25% of subjects eventually took additional therapy because their diarrhea did not respond to BW942C alone. Neurological side effects such as dizziness and light-headedness occurred more frequently among BW942C-treated subjects. Therapy for 3 days with TMP-SMX provided lasting relief comparable with previously reported 5-day therapy. Use of the combination of both agents provided the benefits of prompt relief afforded by BW942C and lasting relief afforded by TMP-SMX. BW942C might prove to be an agent suitable for the treatment of acute diarrhea, with TMP-SMX reserved for treatment of those who do not respond adequately. The empiric use of the combination of BW942C and TMP-SMX appears appropriate for the treatment of severe nondysenteric disease.
mesh_terms: D000930:Antidiarrheals / Q000009:adverse effects / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003967:Diarrhea / Q000188:drug therapy*; D004311:Double-Blind Method; D004338:Drug Combinations / Q000009:adverse effects / Q000627:therapeutic use; D004744:Enkephalin, Methionine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D004745:Enkephalins; D005243:Feces / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008800:Mexico; D011897:Random Allocation; D013420:Sulfamethoxazole / Q000009:adverse effects / Q000627:therapeutic use*; D014195:Travel; D014295:Trimethoprim / Q000009:adverse effects / Q000627:therapeutic use*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D014481:United States
chemical_list: D000930:Antidiarrheals; D004338:Drug Combinations; D004745:Enkephalins; D004744:Enkephalin, Methionine; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; C045617:BW 942C; D014295:Trimethoprim; D013420:Sulfamethoxazole