TY - JOUR
T1 - Treatment of travelers' diarrhea
T2 - Ciprofloxacin plus loperamide compared with ciprofloxacin alone: A placebo-controlled, randomized trial
AU - Taylor, David N.
AU - Sanchez, Jose L.
AU - Candler, William
AU - Thornton, Scott
AU - McQueen, Charles
AU - Echeverria, Peter
PY - 1991/5/1
Y1 - 1991/5/1
N2 - Objective: To compare the safety and efficacy of loperamide used in combination with ciprofloxacin or ciprofloxacin alone for the treatment of travelers' diarrhea. Design: Double-blind, placebo-controlled, randomized clinical trial. Setting: United States Army hospital in Egypt. Participants: United States military personnel with travelers' diarrhea (n = 104) during a military exercise in November 1989. Persons who were noncompliant, had bloody diarrhea, or had received antidiarrheal medications before entry into the study were excluded. Interventions: All participants with travelers' diarrhea were treated with ciprofloxacin, 500 mg twice daily for 3 days. Fifty of these patients were randomly assigned to receive loperamide, a 4-mg first dose and 2 mg for every loose stool (as much as 16 mg/d), and 54 were randomly assigned to receive placebo. Measurements: Enterotoxigenic Escherichia coli was isolated from 57% of patients; Shigella and Salmonella, seen in 4% and 2% of patients, respectively, were not common. Main Results: After 24 hours, the symptoms of 82% of patients in the ciprofloxacin and loperamide group compared with 67% in the ciprofloxacin and placebo group had improved or fully recovered (odds ratio, 2.3; 95% CI, 0.8 to 6.3; P = 0.08). After 48 hours, the symptoms of 90% of both groups had improved or fully recovered. The mean number of stools for those receiving loperamide was not much lower than those who did not receive loperamide after 24 hours (1.9 ± 0.2 [SE] compared with 2.6 ± 0.2) or 48 hours (3.1 ± 0.3 compared with 4.0 ± 0.3) of treatment (P = 0.19). Conclusions: In a region where enterotoxigenic E. coli was the predominant cause of travelers' diarrhea, loperamide combined with ciprofloxacin was not better than treatment with ciprofloxacin alone. Loperamide appeared to have some benefit in the first 24 hours of treatment in patients infected with enterotoxigenic E. coli. Both regimens were safe.
AB - Objective: To compare the safety and efficacy of loperamide used in combination with ciprofloxacin or ciprofloxacin alone for the treatment of travelers' diarrhea. Design: Double-blind, placebo-controlled, randomized clinical trial. Setting: United States Army hospital in Egypt. Participants: United States military personnel with travelers' diarrhea (n = 104) during a military exercise in November 1989. Persons who were noncompliant, had bloody diarrhea, or had received antidiarrheal medications before entry into the study were excluded. Interventions: All participants with travelers' diarrhea were treated with ciprofloxacin, 500 mg twice daily for 3 days. Fifty of these patients were randomly assigned to receive loperamide, a 4-mg first dose and 2 mg for every loose stool (as much as 16 mg/d), and 54 were randomly assigned to receive placebo. Measurements: Enterotoxigenic Escherichia coli was isolated from 57% of patients; Shigella and Salmonella, seen in 4% and 2% of patients, respectively, were not common. Main Results: After 24 hours, the symptoms of 82% of patients in the ciprofloxacin and loperamide group compared with 67% in the ciprofloxacin and placebo group had improved or fully recovered (odds ratio, 2.3; 95% CI, 0.8 to 6.3; P = 0.08). After 48 hours, the symptoms of 90% of both groups had improved or fully recovered. The mean number of stools for those receiving loperamide was not much lower than those who did not receive loperamide after 24 hours (1.9 ± 0.2 [SE] compared with 2.6 ± 0.2) or 48 hours (3.1 ± 0.3 compared with 4.0 ± 0.3) of treatment (P = 0.19). Conclusions: In a region where enterotoxigenic E. coli was the predominant cause of travelers' diarrhea, loperamide combined with ciprofloxacin was not better than treatment with ciprofloxacin alone. Loperamide appeared to have some benefit in the first 24 hours of treatment in patients infected with enterotoxigenic E. coli. Both regimens were safe.
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U2 - 10.7326/0003-4819-114-9-731
DO - 10.7326/0003-4819-114-9-731
M3 - Article
C2 - 2012354
AN - SCOPUS:0025881753
SN - 0003-4819
VL - 114
SP - 731
EP - 734
JO - Annals of internal medicine
JF - Annals of internal medicine
IS - 9
ER -