Traveler’s Diarrhea: Optimal Management
ABSTRACT & COMMENTARY
Synopsis: Oflaxacin with loperamide was shown to be significantly more effective in reducing duration of diarrhea.
Source: Ericsson CD, et al. J Travel Med 1997;4:3-7.
In a recent study, ericsson et al examined the benefits of ofloxacin with or without loperamide in students traveling from the United States to Mexico who developed acute diarrhea of less than two weeks duration. A total of 166 subjects (average age, 27 years) were randomized to receive a single dose of ofloxacin (400 mg), twice-daily ofloxacin (200 mg bid for 3 days), or a single dose of ofloxacin (400 mg) plus loperamide (4 mg once followed by 2 mg after each loose stool).
The combined approach was significantly more effective in reducing the duration of diarrhea. The median time to resolution of diarrhea was 14 hours for the single dose of ofloxacin, 28 hours for the three-day course of ofloxacin, but 0 hours for the combination regimen. For those receiving both agents, 63% had no further stools, and 99% were asymptomatic within 24 hours.
COMMENT BY CAROL KEMPER, MD
In a subgroup analysis, this statistically significant benefit was observed for patients in whom no pathogen was identified or in whom enterotoxigenic E. coli was the cause of diarrhea. No statistically significant difference was found between the treatment regimens for patients with Shigella. Cost issues aside, a single dose of any of the flouroquinolones self-administered with loperamide is the simplest and most effective approach for non-dysenteric traveler’s diarrhea. (Dr. Kemper is Associate Director of the AIDS Program, Division of Infectious Diseases, Santa Clara County Medical Center.)
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