title: Systematic review of loperamide: No proof of antibiotics being superior to loperamide in treatment of mild/moderate travellers' diarrhoea.
abstract: Looking at the worldwide emergency of antimicrobial resistance, international travellers appear to have a central role in spreading the bacteria across the globe. Travellers' diarrhoea (TD) is the most common disease encountered by visitors to the (sub)tropics. Both TD and its treatment with antibiotics have proved significant independent risk factors of colonization by resistant intestinal bacteria while travelling. Travellers should therefore be given preventive advice regarding TD and cautioned about taking antibiotics: mild or moderate TD does not require antibiotics. Logical alternatives are medications with effects on gastrointestinal function, such as loperamide. The present review explores literature on loperamide in treating TD. Adhering to manufacturer's dosage recommendations, loperamide offers a safe and effective alternative for relieving mild and moderate symptoms. Moreover, loperamide taken singly does no predispose to contracting MDR bacteria. Most importantly, we found no proof that would show antibiotics to be significantly more effective than loperamide in treating mild/moderate TD.
authors.affiliation: Inflammation Center, Division of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, POB 348, FIN-00029 HUS, Finland. Electronic address: tinja.laaveri@hus.fi.
authors.forename: Tinja
authors.initials: T
authors.lastname: Lääveri
authors.affiliation: Centre for Clinical Research, Sörmland County Council, Eskilstuna and University of Uppsala, SE 631 88 Eskilstuna, Sweden. Electronic address: jesper.sterne@gmail.com.
authors.forename: Jesper
authors.initials: J
authors.lastname: Sterne
authors.affiliation: Centre for Clinical Research, Sörmland County Council, Eskilstuna and University of Uppsala, SE 631 88 Eskilstuna, Sweden; Karolinska Institutet, Department of Medicine/Solna, Unit for Infectious Diseases, SE 17176 Stockholm, Sweden. Electronic address: lars.rombo@gmail.com.
authors.forename: Lars
authors.initials: L
authors.lastname: Rombo
authors.affiliation: Inflammation Center, Division of Infectious Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, POB 348, FIN-00029 HUS, Finland; Karolinska Institutet, Department of Medicine/Solna, Unit for Infectious Diseases, SE 17176 Stockholm, Sweden; Department of Medicine, University of Helsinki, Finland. Electronic address: anu.kantele@hus.fi.
authors.forename: Anu
authors.initials: A
authors.lastname: Kantele
mesh_terms: D000900:Anti-Bacterial Agents / Q000592:standards* / Q000627:therapeutic use; D000930:Antidiarrheals / Q000009:adverse effects / Q000627:therapeutic use*; D016022:Case-Control Studies; D003967:Diarrhea / Q000188:drug therapy* / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D006801:Humans; D008139:Loperamide / Q000009:adverse effects / Q000592:standards / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D014195:Travel
chemical_list: D000900:Anti-Bacterial Agents; D000930:Antidiarrheals; D008139:Loperamide
keywords: Adverse drug event; Antibiotic resistance; Antibiotics; Antidiarrhoeals; Safety