Treatment of Traveler's Diarrhea with Ciprofloxacin and Loperamide

• Published in: The Journal of infectious diseases Vol. 165; no. 3; pp. 557 - 560
• Main Authors: Petruccelli, Bruno P., Murphy, Gerald S., Sanchez, Jose L., Walz, Stephen, DeFraites, Robert, Gelnett, Jane, Haberberger, Richard L., Echeverria, Peter, Taylor, David N.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 01.03.1992; University of Chicago Press
• Subjects: Antibiotics; Biological and medical sciences; Campylobacter; Campylobacter Infections - drug therapy; Ciprofloxacin - therapeutic use; Concise Communications; Diarrhea; Diarrhea - drug therapy; Diseases; Dosage; Double-Blind Method; Drug Therapy, Combination; Dysentery, Bacillary - drug therapy; Escherichia coli Infections - drug therapy; Humans; Infectious diseases; Liquids; Loperamide - therapeutic use; Medical sciences; Military Personnel; Pathogens; Placebos; Relapse; Salmonella Infections - drug therapy; Thailand; Travel; Travelers; United States; Thailand; United States; Prognosis; Diarrhea; Exploration; Medical screening; Result; Infection; Prevention; Chemotherapy; Treatment; Bacteriosis; Digestive diseases; Evolution; Intestinal disease; Diagnosis; Passenger; Technique
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1093/infdis/165.3.557

To determine the efficacy of loperamide given with long- and short-course quinolone therapy for treating traveler's diarrhea, 142 US military personnel were randomized to receive a single 750-mg dose of ciprofloxacin with placebo, 750 mg of ciproftoxacin with loperamide, or a 3-day course of 500 mg of ciprofloxacin twice daily with loperamide. Culture of pretreatment stool specimens revealed campylobacters (41%), salmonellae (18%), enterotoxigenic Escherichia coli (ETEC, 6%), and shigellae (4%). Of the participants, 87% completely recovered within 72 h of entry. Total duration of illness did not differ significantly among the three treatment groups, but patients in the 3-day ciprofloxacin plus loperamide group reported a lower cumulative number of liquid bowel movements at 48 and 72 h after enrollment compared with patients in the singledose ciprofloxacin plus placebo group (1.8 vs. 3.6, P = .01; 2.0 vs. 3.9, P = .01). While not delivering a remarkable therapeutic advantage, loperamide appears to be safe for treatment of non-ETEC causes of traveler's diarrhea. Two of 54 patients with Campylobacter enteritis had a clinical relapse after treatment that was associated with development of ciprofloxacin resistance.