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Empiric Antimicrobial Therapy of Domestically Acquired Acute Diarrhea in Urban Adults

Empiric Antimicrobial Therapy of Domestically Acquired Acute Diarrhea in Urban Adults Abstract • From June 1985 to September 1987, 202 adults were enrolled in a randomized, double-blinded study comparing ciprofloxacin (500 mg) with sulfamethoxazole and trimethoprim (160 mg/800 mg) or placebo for adults with acute diarrhea. All patients were treated on the day of presentation and received medication on a twice-daily schedule (every 12 hours) for 5 days. Bacterial isolates from these patients included 35 Campylobacter, 18 Shigella, and 15 Salmonella. Treatment at the time of presentation with ciprofloxacin compared with placebo shortened the duration of diarrhea (2.4 vs 3.4 days), and increased the percentage of patients cured or improved by treatment days 1,3,4, and 5. Similar significant differences for sulfamethoxazole and trimethoprim compared with placebo were not seen. (Arch Intern Med. 1990;150:541-546) References 1. Nord CE, Kager L, Heimdahl A. Impact of antimicrobial agents on the gastrointestinal microflora and the risk of infections . Am J Med . 1984;76( (suppl 5A) ):99-106.Crossref 2. Van der Waij D. Antibiotic Choice: The Importance of Colonization Resistance . New York, NY: John Wiley & Sons; 1983. 3. Bryan JP, Rocha H, Scheld WM. Problems in salmonellosis: rationale for clincial trials with newer beta-lactase agents and quinolones . Rev Infect Dis . 1986;8:189-207.Crossref 4. Asirkoff B, Bennett JV. Effect of antibiotic therapy in acute salmonellosis on the fecal excretion of Salmonellae . N Engl J Med . 1969;281:636.Crossref 5. Nelson JD, Kusmiesz H, Jackson LH, Woodman E. Treatment of salmonella gastroenteritis with ampicillin, amoxacillin or placebo . Pediatrics . 1980;65:1125-1130. 6. Anders BJ, Paisley JW, Lauer BA, Reller LB. Double-blind placebo controlled trial of erythromycin for treatment of Campylobacter enteritis . Lancet . 1982;1:131-132.Crossref 7. Ericcson CD, Johnson PC, DuPont HL, Morgan DR, Bitsura JM, Javier DeLaCabada F. Ciprofloxacin or trimethoprim-sulfamethoxazole as initial therapy for traveler's diarrhea . Ann Intern Med . 1987;106:216-220.Crossref 8. Kelly MT, Brenner DJ, Farmer III JJ. ' Enterobacteriacieae .' In: Lennette EH, Belows A, Hausley WJ Jr, Shadomy HJ, eds. Manual of Clinical Microbiology . 4th ed. 1985:263-277, 302-308. 9. Morris GK, Patten CM. ' Campylobacter .' In: Lennette EH, Belows A, Hausley WJ Jr, Shadomy HJ, eds. Manual of Clinical Microbiology . 4th ed. 1985:302-308. 10. Harris AA, Kaplan RL, Goodman LJ, et al. Results of a screening method used in a twelve-month stool survey for Escherichia coli 0157:H7 . J Infect Dis . 1985;152:775-777.Crossref 11. Chang TW, Lauermann M, Bartlett JG. Cytotoxic assay in antibiotic associated colitis . J Infect Dis . 1979;140:765-770.Crossref 12. Bronsdon MA. Rapid dimethyl sulfoxide modified acid-fast stain of cryptosporidium oocysts in stool specimens . J Clin Microbiol . 1984; 19:952-953. 13. Goodman LJ, Fliegelman RM, Trenholme GM, Kaplan RL. Comparative in vitro activity of ciprofloxacin against Campylobacter spp and other bacterial enteric pathogens . Antimicrob Agents Chemother . 1984;25:504-506.Crossref 14. Goodman LJ, Kaplan RL, Petrak RM, et al. Effects of erythromycin and ciprofloxacin on chronic fecal excretion of Campylobacter species in marmosets . Antimicrob Agents Chemother . 1986;29:185-187.Crossref 15. Sanders CC, Sanders WE, Goerging RV. Overview of preclinical studies with ciprofloxacin . Am J Med . 1987;82:2-11.Crossref 16. Norel CE. Effect of new quinolones on the human gastrointestinal microflora . Rev Infect Dis . 1988;10( (suppl 1) ):5193-5196. 17. Chang MJ, Dunkie LM, Reken DV, Anderson D, Wong ML, Feigin RA. Trimethoprime-sulfamethoxazole compared to ampicillin for the treatment of shigellosis . Pediatrics . 1977;59:726-729. 18. DiJohn D, Levine MM. Treatment of diarrhea . Infect Dis Clin North Am . 1988;2:719-745. 19. Pichler HET, Diridl G, Stickler K, Dietmar W. Clinical efficiency of ciprofloxacin compared with placebo in bacterial diarrhea . Am J Med . 1987;82( (suppl 4A) ):329-332.Crossref 20. DuPont HL. Diarrheal diseases: an overview . Am J Med . 1985;78( (suppl 6B) ):63-64.Crossref 21. Gilchrest MJR, Bretl TS, Moultney K, Knowlton DR, Ward RL. Comparison of seven kits for detection of rotavirus in fecal specimens with a sensitive, specific enzyme immunoassay . Diagn Microbiol Infect Dis . 1987; 8:221-228.Crossref 22. Nelson JD, Kusmiesz H, Jackson LH. Comparison of trimethoprimsulfamethoxazole and ampicillin therapy for shigellosis in ambulatory patients . J Pediatr . 1976;89:491-493.Crossref 23. Hooper DC, Wolfson JS, Ng EY, Swartz MN. Mechanism of action and resistance to ciprofloxacin . Am J Med . 1987;82( (suppl 4A) ):12-20. 24. Neu HC. Bacterial resistance to flouroquinolones . Rev Infect Dis . 1988; 10 ( (suppl 1) ):S57-S63.Crossref 25. Lastovica AJ, LeRoux E, Penner JL. Mixed infections with different species and serotypes of Campylobacter . J Infect Dis . 1986;54:375.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1990 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1990.00390150047009
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Abstract

Abstract • From June 1985 to September 1987, 202 adults were enrolled in a randomized, double-blinded study comparing ciprofloxacin (500 mg) with sulfamethoxazole and trimethoprim (160 mg/800 mg) or placebo for adults with acute diarrhea. All patients were treated on the day of presentation and received medication on a twice-daily schedule (every 12 hours) for 5 days. Bacterial isolates from these patients included 35 Campylobacter, 18 Shigella, and 15 Salmonella. Treatment at the time of presentation with ciprofloxacin compared with placebo shortened the duration of diarrhea (2.4 vs 3.4 days), and increased the percentage of patients cured or improved by treatment days 1,3,4, and 5. Similar significant differences for sulfamethoxazole and trimethoprim compared with placebo were not seen. (Arch Intern Med. 1990;150:541-546) References 1. Nord CE, Kager L, Heimdahl A. Impact of antimicrobial agents on the gastrointestinal microflora and the risk of infections . Am J Med . 1984;76( (suppl 5A) ):99-106.Crossref 2. Van der Waij D. Antibiotic Choice: The Importance of Colonization Resistance . New York, NY: John Wiley & Sons; 1983. 3. Bryan JP, Rocha H, Scheld WM. Problems in salmonellosis: rationale for clincial trials with newer beta-lactase agents and quinolones . Rev Infect Dis . 1986;8:189-207.Crossref 4. Asirkoff B, Bennett JV. Effect of antibiotic therapy in acute salmonellosis on the fecal excretion of Salmonellae . N Engl J Med . 1969;281:636.Crossref 5. Nelson JD, Kusmiesz H, Jackson LH, Woodman E. Treatment of salmonella gastroenteritis with ampicillin, amoxacillin or placebo . Pediatrics . 1980;65:1125-1130. 6. Anders BJ, Paisley JW, Lauer BA, Reller LB. Double-blind placebo controlled trial of erythromycin for treatment of Campylobacter enteritis . Lancet . 1982;1:131-132.Crossref 7. Ericcson CD, Johnson PC, DuPont HL, Morgan DR, Bitsura JM, Javier DeLaCabada F. Ciprofloxacin or trimethoprim-sulfamethoxazole as initial therapy for traveler's diarrhea . Ann Intern Med . 1987;106:216-220.Crossref 8. Kelly MT, Brenner DJ, Farmer III JJ. ' Enterobacteriacieae .' In: Lennette EH, Belows A, Hausley WJ Jr, Shadomy HJ, eds. Manual of Clinical Microbiology . 4th ed. 1985:263-277, 302-308. 9. Morris GK, Patten CM. ' Campylobacter .' In: Lennette EH, Belows A, Hausley WJ Jr, Shadomy HJ, eds. Manual of Clinical Microbiology . 4th ed. 1985:302-308. 10. Harris AA, Kaplan RL, Goodman LJ, et al. Results of a screening method used in a twelve-month stool survey for Escherichia coli 0157:H7 . J Infect Dis . 1985;152:775-777.Crossref 11. Chang TW, Lauermann M, Bartlett JG. Cytotoxic assay in antibiotic associated colitis . J Infect Dis . 1979;140:765-770.Crossref 12. Bronsdon MA. Rapid dimethyl sulfoxide modified acid-fast stain of cryptosporidium oocysts in stool specimens . J Clin Microbiol . 1984; 19:952-953. 13. Goodman LJ, Fliegelman RM, Trenholme GM, Kaplan RL. Comparative in vitro activity of ciprofloxacin against Campylobacter spp and other bacterial enteric pathogens . Antimicrob Agents Chemother . 1984;25:504-506.Crossref 14. Goodman LJ, Kaplan RL, Petrak RM, et al. Effects of erythromycin and ciprofloxacin on chronic fecal excretion of Campylobacter species in marmosets . Antimicrob Agents Chemother . 1986;29:185-187.Crossref 15. Sanders CC, Sanders WE, Goerging RV. Overview of preclinical studies with ciprofloxacin . Am J Med . 1987;82:2-11.Crossref 16. Norel CE. Effect of new quinolones on the human gastrointestinal microflora . Rev Infect Dis . 1988;10( (suppl 1) ):5193-5196. 17. Chang MJ, Dunkie LM, Reken DV, Anderson D, Wong ML, Feigin RA. Trimethoprime-sulfamethoxazole compared to ampicillin for the treatment of shigellosis . Pediatrics . 1977;59:726-729. 18. DiJohn D, Levine MM. Treatment of diarrhea . Infect Dis Clin North Am . 1988;2:719-745. 19. Pichler HET, Diridl G, Stickler K, Dietmar W. Clinical efficiency of ciprofloxacin compared with placebo in bacterial diarrhea . Am J Med . 1987;82( (suppl 4A) ):329-332.Crossref 20. DuPont HL. Diarrheal diseases: an overview . Am J Med . 1985;78( (suppl 6B) ):63-64.Crossref 21. Gilchrest MJR, Bretl TS, Moultney K, Knowlton DR, Ward RL. Comparison of seven kits for detection of rotavirus in fecal specimens with a sensitive, specific enzyme immunoassay . Diagn Microbiol Infect Dis . 1987; 8:221-228.Crossref 22. Nelson JD, Kusmiesz H, Jackson LH. Comparison of trimethoprimsulfamethoxazole and ampicillin therapy for shigellosis in ambulatory patients . J Pediatr . 1976;89:491-493.Crossref 23. Hooper DC, Wolfson JS, Ng EY, Swartz MN. Mechanism of action and resistance to ciprofloxacin . Am J Med . 1987;82( (suppl 4A) ):12-20. 24. Neu HC. Bacterial resistance to flouroquinolones . Rev Infect Dis . 1988; 10 ( (suppl 1) ):S57-S63.Crossref 25. Lastovica AJ, LeRoux E, Penner JL. Mixed infections with different species and serotypes of Campylobacter . J Infect Dis . 1986;54:375.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Mar 1, 1990

References