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Antibiotics in travellers diarrhoea

Three Part Question

In [patients with travellers diarrhoea] do [antibiotics] reduce [the duration of diarrhoea]?

Clinical Scenario

A 32 years old male presented to the A & E Department with bloody stools, fever after his return from holiday abroad. He had moderate signs of dehydration & was given IV Fluids. The next question was whether to start him on antibiotics or not

Search Strategy

Search strategy using medline ovid interphase 1966- to present
({exp TRAVEL/or travel.mp} AND {DIARRHOEA/ or diarrhoea. mp} AND { ANTIBIOTICS/ or antibiotics mp}) limit to human AND english

Search Outcome

10 papers were found of which 6 were of insufficient quality. The remaining four papers are as follows

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Salam I et al
1994
USA
88 subjects enrolled, 83 were evaluable. 45 received single dose of 500mg Ciprofloxacin, 38 received placeboplacebo controlled randomised trialReduction in the duration & severity of diarrhoea in the group treated with ciprofloxacin20.9 hours Vs 50.4 hours ( P <0.0001)The numbers are too small
De Bruyn G, Hahn S, Borwick A.
2000
USA
12 out of 20 studies were placebo controlledsystematic reviewAntibiotic treatment is associated with shorter duration of diarrhoeaData from six trials odds ratio [OR] 5. 9Increased side effects with antibiotics
Wistrom J et al
1989
Sweden
Out of 94, 46 received norfloxacin 400 mg bd 3/7 and 48 placeborandomized, double blind, placebo-controlled, multicentre trialAfter 3 days statistically significant number of patients were cured in the norfloxacin groupP = 0.0001Compliance might be problem
Steffen R, Jori J, DuPont HL, Mathewson JJ, Sturchler D
1993
Switzerland
Out of 151, 54- fleroxacin 400mg- 1day, 48 fleroxacin 400mg 2days, 49 -placeboRandomized Controlled Trialfleroxacin was significantly superior to placeboNo significant difference in terms of efficacy between the one- and two-day regimensIncreased side effects with antibiotics

Comment(s)

All four papers found antibiotics to be effective in reducing the duration of diarrhoea. Three different antibiotics have been used in these trials. All three were found to be effective

Clinical Bottom Line

Antibiotics do reduce the duration of diarrhoea in travellers diarrhoea but can be associated with side effects

References

  1. Salam I et al Randomised trial of single-dose ciprofloxacin for travellers' diarrhoea Lancet 1994 Dec 3;344(8936):1537-9.
  2. De Bruyn G, Hahn S, Borwick A. Antibiotic treatment for travellers' diarrhoea Cochrane Database Syst Rev 2000;(3):CD002242
  3. Wistrom J et al Short-term self-treatment of travellers' diarrhoea with norfloxacin: a placebo-controlled study J Antimicrob Chemother 1989 Jun;23(6):905-13.
  4. Steffen R, Jori J, DuPont HL, Mathewson JJ, Sturchler D Treatment of travellers' diarrhoea with fleroxacin: a case study J Antimicrob Chemother 1993 May;31(5):767-76