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January 12, 1990, Vol 263, No. 2 >
ARTICLE | January 12, 1990

Treatment of Traveler's Diarrhea With Sulfamethoxazole and Trimethoprim and Loperamide FREE

Charles D. Ericsson, MD; Herbert L. DuPont, MD; John J. Mathewson, PhD; M. Stewart West, PhD; Philip C. Johnson, MD; Jo Ann M. Bitsura, MPH
[+] Author Affiliations

Presented at the Annual Meeting of the American Federation of Clinical Research, Washington, DC, April 28,1988.

Reprint requests to Division of Infectious Diseases, Department of Medicine, University of Texas Medical School at Houston, 6431 Fannin St, Room 1.728, Houston, TX 77030 (Dr Ericsson).


JAMA. 1990;263(2):257-261. doi:10.1001/jama.1990.03440020091039
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References

In a randomized, double-blind, placebo-controlled trial, 227 US adults with acute diarrhea in Mexico received a single dose of sulfamethoxazole and trimethoprim (1600/320 mg) or 3 days of therapy with loperamide hydrochloride (4-mg loading dose, then 2 mg orally after each loose stool), sulfamethoxazole-trimethoprim (800/160 mg orally twice daily), or the combination of both. Subjects treated with the combination had the shortest average duration of diarrhea compared with the placebo group (1 hour vs 59 hours), took the least amount of loperamide after the loading dose (3.8 mg), and had the shortest duration of diarrhea associated with fecal leukocytes or blood-tinged stools (4.5 hours). A single dose of sulfamethoxazole-trimethoprim was also efficacious (28 vs 59 hours), but loperamide alone was significantly effective only when treatment failures were treated with antibiotics (33 vs 58 hours). The combination of sulfamethoxazole-trimethoprim plus loperamide can be highly recommended for the treatment of most patients with travelers diarrhea.

(JAMA. 1990;263:257-261)

REFERENCES

1 +
Ericsson CD, DuPont HL.  Travelers' diarrhea: recent developments . In: Remington JS, Swartz MN, eds. Current Clinical Topics in Infectious Diseases . New York, NY: McGraw-Hill International Book Co; 1985;;6:66-84.
2 +
 Travelers' diarrhea . JAMA . 1985;;253:2700-2704. Consensus Conference.
3 +
Ericsson CD, DuPont HL.  Antimicrobial agents in the management of travelers' diarrhea . In: Peterson PK, Verhoef J, eds. The Antimicrobial Agents Annual . Amsterdam, the Netherlands: Elsevier Science Publishers; 1988;;3:541-551.
4 +
Ericsson CD, DuPont HL, Johnson PC.  Nonantibiotic therapy for travelers' diarrhea . Rev Infect Dis. 1986;;8( (suppl 2) ):S202-S204.
5 +
Johnson PC, Ericsson CD, DuPont HL, Morgan DR, Bitsura JAM, Wood LV.  Comparison of loper-amide with bismuth subsalicylate for the treatment of acute travelers' diarrhea . JAMA . 1986;;255:757-760.
6 +
Ericsson CD, Johnson PC, DuPont HL, Morgan DR.  Role of a novel antimicrobial agent, BW942C, used alone or in combination with trimethoprim/ sulfamethoxazole in the treatment of travelers' diarrhea . Antimicrob Agents Chemother. 1986;; 29:1040-1046.
7 +
Pickering LK, DuPont HL, Olarte J.  Single-dose tetracycline for shigellosis in adults . JAMA . 1978;;239:853-854.
8 +
Oldfield EC III, Bourgeois AL, Omar A-KM, Pazzaghia GL.  Empirical treatment of Shigella dysentery with trimethoprim: five-day course vs single dose . Am J Trop Med Hyg. 1987;;37:616-623.
9 +
Goutuzzo E, Oberhelman RA, Maguina C, et al.  Comparison of single-dose treatment with trimethoprim-sulfamethoxazole for acute shigellosis in adults . Antimicrob Agents Chemother. 1989;; 33:1101-1104.
10 +
Mathewson JJ, Oberhelman RA, DuPont HL, de la Cabada FJ, Garibay EV.  Enteroadherent Escherichia coli as a cause of diarrhea among children in Mexico . J Clin Microbiol. 1987;;25:1917-1919.
11 +
Murray BE, Mathewson JJ, DuPont HL, Hill WE.  Utility of oligodesoxyribonucleotide probes for detecting enterotoxigenic Escherichia coli . J Infect Dis. 1987;;155:809-811.
12 +
Ericsson CD, Johnson PC, DuPont HL, Morgan DR, Bitsura JAM, de la Cabada PJ.  Ciprofloxacin or trimethoprim/sulfamethoxazole as initial therapy for travelers' diarrhea . Ann Intern Med. 1987;;106:216-220.
13 +
Ericsson CD, DuPont HL, Sullivan P, Galindo E, Evans DG, Evans DJ Jr.  Bicozamycin, a poorly absorbable antibiotic, effectively treats travelers' diarrhea . Ann Intern Med. 1983;;98:20-25.
14 +
Anderson S, Auquier A, Hauck WW, Oakes D, Vandaele W, Weisberg HI. Statistical Methods for Comparative Studies . New York, NY: John Wiley & Sons Inc; 1980;.
15 +
 Drop-outs from clinical trials . Lancet . 1987;; 2:892-893. Editorial.
16 +
Zimmer WJ, Brown JT, Linzer M.  Randomization in clinical trials . Ann Intern Med. 1987;; 107:790.
17 +
Ericsson CD, Patterson TF, DuPont HL.  Clinical presentation as a guide to therapy for travelers' diarrhea . Am J Med Sci. 1987;;30:91-96.
18 +
DuPont HL, Hornick RB.  Adverse effect of Lomotil therapy in shigellosis . JAMA . 1973;; 226:1525-1528.
19 +
Parsonnet J, Greene KD, Gerber AR, Tauxe RV, Vallejo Aguilar OJ, Blake PA.  Shigella dysenteriae type 1 infections in U.S. travellers to Mexico, 1988 . Lancet . 1989;;2:543-545.
20 +
Butler T, Islam MR, Azad MAK, Jones PK.  Risk factors for development of hemolytic uremic syndrome during shigellosis . J Pediatr. 1987;; 110:894-897.
21 +
Taylor N, Houston R, Shlim DR, Bhaibulaya M, Ungar BLP, Echeverria P.  Etiology of diarrhea among travelers and foreign residents in Nepal . JAMA . 1988;;260:1245-1248.
22 +
Farrar WE.  Antibiotic resistance in developing countries . J Infect Dis. 1985;;152:1103-1106.

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1 +
Ericsson CD, DuPont HL.  Travelers' diarrhea: recent developments . In: Remington JS, Swartz MN, eds. Current Clinical Topics in Infectious Diseases . New York, NY: McGraw-Hill International Book Co; 1985;;6:66-84.
2 +
 Travelers' diarrhea . JAMA . 1985;;253:2700-2704. Consensus Conference.
3 +
Ericsson CD, DuPont HL.  Antimicrobial agents in the management of travelers' diarrhea . In: Peterson PK, Verhoef J, eds. The Antimicrobial Agents Annual . Amsterdam, the Netherlands: Elsevier Science Publishers; 1988;;3:541-551.
4 +
Ericsson CD, DuPont HL, Johnson PC.  Nonantibiotic therapy for travelers' diarrhea . Rev Infect Dis. 1986;;8( (suppl 2) ):S202-S204.
5 +
Johnson PC, Ericsson CD, DuPont HL, Morgan DR, Bitsura JAM, Wood LV.  Comparison of loper-amide with bismuth subsalicylate for the treatment of acute travelers' diarrhea . JAMA . 1986;;255:757-760.
6 +
Ericsson CD, Johnson PC, DuPont HL, Morgan DR.  Role of a novel antimicrobial agent, BW942C, used alone or in combination with trimethoprim/ sulfamethoxazole in the treatment of travelers' diarrhea . Antimicrob Agents Chemother. 1986;; 29:1040-1046.
7 +
Pickering LK, DuPont HL, Olarte J.  Single-dose tetracycline for shigellosis in adults . JAMA . 1978;;239:853-854.
8 +
Oldfield EC III, Bourgeois AL, Omar A-KM, Pazzaghia GL.  Empirical treatment of Shigella dysentery with trimethoprim: five-day course vs single dose . Am J Trop Med Hyg. 1987;;37:616-623.
9 +
Goutuzzo E, Oberhelman RA, Maguina C, et al.  Comparison of single-dose treatment with trimethoprim-sulfamethoxazole for acute shigellosis in adults . Antimicrob Agents Chemother. 1989;; 33:1101-1104.
10 +
Mathewson JJ, Oberhelman RA, DuPont HL, de la Cabada FJ, Garibay EV.  Enteroadherent Escherichia coli as a cause of diarrhea among children in Mexico . J Clin Microbiol. 1987;;25:1917-1919.
11 +
Murray BE, Mathewson JJ, DuPont HL, Hill WE.  Utility of oligodesoxyribonucleotide probes for detecting enterotoxigenic Escherichia coli . J Infect Dis. 1987;;155:809-811.
12 +
Ericsson CD, Johnson PC, DuPont HL, Morgan DR, Bitsura JAM, de la Cabada PJ.  Ciprofloxacin or trimethoprim/sulfamethoxazole as initial therapy for travelers' diarrhea . Ann Intern Med. 1987;;106:216-220.
13 +
Ericsson CD, DuPont HL, Sullivan P, Galindo E, Evans DG, Evans DJ Jr.  Bicozamycin, a poorly absorbable antibiotic, effectively treats travelers' diarrhea . Ann Intern Med. 1983;;98:20-25.
14 +
Anderson S, Auquier A, Hauck WW, Oakes D, Vandaele W, Weisberg HI. Statistical Methods for Comparative Studies . New York, NY: John Wiley & Sons Inc; 1980;.
15 +
 Drop-outs from clinical trials . Lancet . 1987;; 2:892-893. Editorial.
16 +
Zimmer WJ, Brown JT, Linzer M.  Randomization in clinical trials . Ann Intern Med. 1987;; 107:790.
17 +
Ericsson CD, Patterson TF, DuPont HL.  Clinical presentation as a guide to therapy for travelers' diarrhea . Am J Med Sci. 1987;;30:91-96.
18 +
DuPont HL, Hornick RB.  Adverse effect of Lomotil therapy in shigellosis . JAMA . 1973;; 226:1525-1528.
19 +
Parsonnet J, Greene KD, Gerber AR, Tauxe RV, Vallejo Aguilar OJ, Blake PA.  Shigella dysenteriae type 1 infections in U.S. travellers to Mexico, 1988 . Lancet . 1989;;2:543-545.
20 +
Butler T, Islam MR, Azad MAK, Jones PK.  Risk factors for development of hemolytic uremic syndrome during shigellosis . J Pediatr. 1987;; 110:894-897.
21 +
Taylor N, Houston R, Shlim DR, Bhaibulaya M, Ungar BLP, Echeverria P.  Etiology of diarrhea among travelers and foreign residents in Nepal . JAMA . 1988;;260:1245-1248.
22 +
Farrar WE.  Antibiotic resistance in developing countries . J Infect Dis. 1985;;152:1103-1106.

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