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 placebo | placebo controlled randomised trial | Reduction in the duration & severity of diarrhoea in the group treated with ciprofloxacin | 20.9 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 controlled | systematic review | Antibiotic treatment is associated with shorter duration of diarrhoea | Data from six trials odds ratio [OR] 5. 9 | Increased side effects with antibiotics |
Wistrom J et al 1989 Sweden | Out of 94, 46 received norfloxacin 400 mg bd 3/7 and 48 placebo | randomized, double blind, placebo-controlled, multicentre trial | After 3 days statistically significant number of patients were cured in the norfloxacin group | P = 0.0001 | Compliance 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 -placebo | Randomized Controlled Trial | fleroxacin was significantly superior to placebo | No significant difference in terms of efficacy between the one- and two-day regimens | Increased 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
- Salam I et al Randomised trial of single-dose ciprofloxacin for travellers' diarrhoea Lancet 1994 Dec 3;344(8936):1537-9.
- De Bruyn G, Hahn S, Borwick A. Antibiotic treatment for travellers' diarrhoea Cochrane Database Syst Rev 2000;(3):CD002242
- 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.
- 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