Antibiotics in travellers diarrhoea
Date First Published:
October 29, 2003
Last Updated:
January 21, 2004
Report by:
Dr.T.Venugopal, SHO (Queen Elizabeth Hospital, Gateshead)
Search checked by:
Dr A Adair, Queen Elizabeth Hospital, Gateshead
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
Search Details:
({exp TRAVEL/or travel.mp} AND {DIARRHOEA/ or diarrhoea. mp} AND { ANTIBIOTICS/ or antibiotics mp}) limit to human AND english
Outcome:
10 papers were found of which 6 were of insufficient quality. The remaining four papers are as follows
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Randomised trial of single-dose ciprofloxacin for travellers' diarrhoea 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 |
| Antibiotic treatment for travellers' diarrhoea 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 |
| Short-term self-treatment of travellers' diarrhoea with norfloxacin: a placebo-controlled study 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 |
| Treatment of travellers' diarrhoea with fleroxacin: a case study 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 |
Author Commentary:
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
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
- De Bruyn G, Hahn S, Borwick A.. Antibiotic treatment for travellers' diarrhoea
- Wistrom J et al. Short-term self-treatment of travellers' diarrhoea with norfloxacin: a placebo-controlled study
- Steffen R, Jori J, DuPont HL, Mathewson JJ, Sturchler D. Treatment of travellers' diarrhoea with fleroxacin: a case study