Effects of pre-deployment loperamide provision on use and travelers' diarrhea outcomes among U.S. military personnel deployed to Turkey.
OBJECTIVE
This study assessed the efficacy of education and self-treatment with loperamide on diarrhea morbidity and healthcare utilization in a deployed military setting.


METHODS
In this prospective, controlled study, volunteers from military personnel deployed to Incirlik Air Base received either travelers' diarrhea education (non-loperamide group) or education plus a supply of loperamide (loperamide group). Volunteers were surveyed to determine frequency and outcomes of diarrheal illness.


RESULTS
109 deployed personnel were enrolled with 48 assigned to the loperamide group, and 61 to the non-loperamide group. Overall, 41 (38%) service members had at least one diarrheal episode. Only 10 (9%) service members sought treatment from a healthcare provider and the distribution was similar in both groups. Loperamide use for self-treatment was more common in the loperamide group (85%) vs. (57%), [p = 0.02]) but use of antibiotics was similar in both groups (loperamide (30%) vs. non-loperamide (20%).


CONCLUSIONS
Provision of loperamide and education did not significantly affect healthcare utilization or antibiotic use to manage diarrheal episodes, when compared to education alone. Further prospective studies will either need a very large patient population to power them or should use other primary end points such a functional assessment in addition to seeking care.
Department of Internal Medicine, Walter Reed National Military Medical Center, 8901 Wisconsin Ave., Bethesda, MD 20889, USA. Electronic address: Andrew.G.Letizia.mil@health.mil.
Andrew
A
Letizia
Enteric Diseases Department, Naval Medical Research Center, 503 Robert Grant Ave., Silver Spring, MD 20910, USA.
Mark S
MS
Riddle
Enteric Diseases Department, Naval Medical Research Center, 503 Robert Grant Ave., Silver Spring, MD 20910, USA; Uniformed Services University of Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA.
David
D
Tribble
Naval Medical Research Unit 3, PSC 452 Box 5000, FPO AE 09835, Egypt.
Manal
M
Mostafa
Naval Medical Research Unit 3, PSC 452 Box 5000, FPO AE 09835, Egypt.
Marshall
M
Monteville
Uniformed Services University of Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA.
Adam
A
Armstrong
Enteric Diseases Department, Naval Medical Research Center, 503 Robert Grant Ave., Silver Spring, MD 20910, USA.
Ramiro L
RL
Gutierrez
D000930:Antidiarrheals / Q000008:administration & dosage / Q000627:therapeutic use*; D003967:Diarrhea / Q000188:drug therapy* / Q000453:epidemiology*; D005260:Female; D006266:Health Education; D006801:Humans; D008139:Loperamide / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data*; D011446:Prospective Studies; D014195:Travel / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014421:Turkey; D014481:United States / Q000453:epidemiology
D000930:Antidiarrheals; D008139:Loperamide
Diarrhea self-treatment; Loperamide; Traveler's diarrhea