Asunto(s)
Antiinfecciosos/administración & dosificación , Antidiarreicos/administración & dosificación , Diarrea/tratamiento farmacológico , Loperamida/administración & dosificación , Ofloxacino/administración & dosificación , Viaje , Adulto , Esquema de Medicación , Quimioterapia Combinada , Femenino , Humanos , Masculino , MéxicoRESUMEN
Enteroaggregative Escherichia coli (EAEC) has been reported to cause traveler's diarrhea and persistent diarrhea in children in developing countries and in immunocompromised patients. To clarify the prevalence of EAEC in traveler's diarrhea, we studied 636 US, Canadian, or European travelers with diarrhea: 218 in Guadalajara, Mexico (June--August 1997 and 1998), 125 in Ocho Rios, Jamaica (September 1997--May 1998), and 293 in Goa, India (January 1997--April 1997 and October 1997--February 1998). Stool samples were tested for conventional enteropathogens. EAEC strains were identified by use of the HEp-2 assay. EAEC was isolated in 26% of cases of traveler's diarrhea (ranging from 19% in Goa to 33% in Guadalajara) and was second only to enterotoxigenic E. coli as the most common enteropathogen in all areas. Identification of EAEC reduced the number of cases for which the pathogen was unknown from 327 (51%) to 237 (37%) and explained 28% of cases with unknown etiology. EAEC was a major cause of traveler's diarrhea in 3 geographically distinct study areas.
Asunto(s)
Diarrea/microbiología , Infecciones por Escherichia coli/microbiología , Salud Global , Viaje , Adulto , Diarrea/epidemiología , Escherichia coli/clasificación , Escherichia coli/genética , Escherichia coli/crecimiento & desarrollo , Escherichia coli/aislamiento & purificación , Infecciones por Escherichia coli/epidemiología , Femenino , Humanos , India/epidemiología , Jamaica/epidemiología , Masculino , México/epidemiología , Prevalencia , Células Tumorales CultivadasRESUMEN
Thirty-nine healthy US students without diarrheal disease and who had not received prophylactic or therapeutic antibiotics were monitored for emergence of trimethoprim-resistant gram-negative fecal flora for a 3-week period after arrival in Guadalajara, Mexico. During this time period, most students showed no change in total fecal gram-negative bacteria (p > 0.05) but showed an increasing level of trimethoprim (TMP) resistance (p < 0.01) among fecal coliforms. Escherichia coli was the TMP-resistant organism isolated in 18 of 39 (46%) healthy students. These 18 TMP-resistant E. coli were also resistant to ampicillin (44%), azithromycin (11%), chloramphenicol (39%), ciprofloxacin (11%), doxycycline (89%), erythromycin (100%), furazolidone (72%), levofloxacin (17%), trimethoprim-sulfamethoxazole (89%) and trovafloxacin (17%). In the absence of prophylactic and therapeutic antibiotics, increased acquisition of TMP-resistant gram-negative fecal flora in this developing country is probably due to poor sanitary conditions and the recurrent and heavy exposure to antimicrobial-resistant indigenous flora as a result of contaminated food and drink.
Asunto(s)
Escherichia coli/efectos de los fármacos , Heces/microbiología , Resistencia al Trimetoprim , Adolescente , Adulto , Antibacterianos/uso terapéutico , Profilaxis Antibiótica , Farmacorresistencia Microbiana , Escherichia coli/aislamiento & purificación , Femenino , Humanos , Masculino , México , ViajeRESUMEN
We examined stool samples from travelers for secretory immunoglobulin A (sIgA) to enteroaggregative Escherichia coli (EAEC) during episodes of acute diarrhea. Ten paired samples from 10 patients with diarrhea caused by EAEC were examined for the presence of specific sIgA by dot blot and Western blot immunoassays. Five samples were positive by dot blotting, and two samples were positive by Western blotting.
Asunto(s)
Diarrea/diagnóstico , Infecciones por Escherichia coli/diagnóstico , Inmunoglobulina A/análisis , Adulto , Antígenos Bacterianos/análisis , Antígenos Bacterianos/inmunología , Western Blotting , Enfermedad Crónica , Diarrea/inmunología , Infecciones por Escherichia coli/inmunología , Heces/microbiología , Humanos , Immunoblotting , Intestinos/inmunología , México , ViajeRESUMEN
The relationship between enterotoxigenic Escherichia coli (ETEC) and travelers' diarrhea was examined in a high-risk area in 1992-1997. Toxin patterns, colonization-factor antigens (CFAs), and in vitro antimicrobial susceptibility were determined. In total, 928 US students with diarrhea acquired in Guadalajara, Mexico, were screened for enteric pathogens. Diagnosis of ETEC infection was done with oligonucleotide probes. ETEC was isolated in 19.9% of the travelers with diarrhea. CFAs were identified in 51% of the ETEC strains. The highest CFA frequency was observed among heat-stable isolates. Ampicillin, furazolidone, and sulfisoxazole resistance of ETEC increased during the study period. ETEC isolation rates and CFA patterns varied little during the 6 years of the study, which has implications for immunoprophylactic strategies. The finding that differences in the results of ribotyping and plasmid analysis change over time suggests that multiple strains of ETEC were responsible for the illness in the region studied.
Asunto(s)
Antibacterianos/farmacología , Proteínas Bacterianas/biosíntesis , Diarrea/microbiología , Enterotoxinas/biosíntesis , Infecciones por Escherichia coli/microbiología , Escherichia coli/fisiología , Proteínas Fimbrias , Adolescente , Adulto , ADN Ribosómico/análisis , Diarrea/epidemiología , Enterobacteriaceae/aislamiento & purificación , Escherichia coli/efectos de los fármacos , Escherichia coli/genética , Escherichia coli/aislamiento & purificación , Heces/microbiología , Humanos , México , Pruebas de Sensibilidad Microbiana , Plásmidos/genética , Reacción en Cadena de la Polimerasa , ARN Ribosómico 16S/genética , ARN Ribosómico 23S/genética , Estudiantes , ViajeRESUMEN
A study was done to test the effectiveness of fecal occult blood as a screening test for invasive bacterial pathogens and as a substitute for the fecal leukocyte examination in adult and pediatric cases of acute diarrhea. United States citizens studying in Mexico and Mexican children, both with acute diarrhea had their stools cultured, examined for fecal leukocytes, and tested for occult blood. Using culture results as the criterion standard for detection of bacterial agents, and fecal leukocytes for diarrhea associated with diffuse colonic inflammation, occult blood was tested for its sensitivity, specificity, and predictive value using 2 x 2 tables. Analysis of the data found that occult blood negative samples were reliable indicators of a lack of invasive bacteria in both adult and pediatric patients (negative predictive values of 87% and 96%, respectively). Positive results for either test were not reliably predictive as indicators of invasive bacteria among adults. A positive occult blood test result was significantly more sensitive than a positive fecal leukocyte test result (79% versus 42%) in detecting invasive bacteria in the pediatric patients; however, the positive predictive value was only 24%. The fecal occult blood test is an uncomplicated, low-cost test that was reliable when giving a negative result in detecting a lack of invasive bacteria in adult and pediatric patients with diarrhea. In children, a positive result on a fecal occult blood test is sensitive but not specific in detecting invasive bacterial enteropathogens. These data also indicate that a commercially available test for occult blood represents a suitable alternative to microscopic examination of fecal samples for leukocytes obtained from patients with acute diarrhea.
Asunto(s)
Infecciones Bacterianas/diagnóstico , Diarrea Infantil/diagnóstico , Diarrea/diagnóstico , Heces/citología , Leucocitos , Sangre Oculta , Enfermedad Aguda , Adulto , Niño , Preescolar , Humanos , Lactante , México , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Viaje , Estados UnidosRESUMEN
The present study was undertaken to compare the efficacy of a new calmodulin antagonist, zaldaride maleate, with that of placebo or loperamide in persons with traveler's diarrhea. One hundred seventy-nine patients were randomized to receive loperamide (4 mg followed by 2 mg after each unformed stool), zaldaride maleate (20 mg four times per day), or placebo. During the initial 48 hours of therapy, zaldaride maleate decreased the number of unformed stools by 30% and the duration of illness by 23% when compared with placebo. Loperamide was superior to both zaldaride maleate and placebo during the initial hours of treatment. However, after 48 hours of treatment, loperamide and zaldaride maleate were equally efficacious, decreasing by > 50% the number of unformed stools passed in a 24-hour interval (P, not significant), and were both superior when compared with placebo (P < .0001 and P = .0048, respectively). The apparent superiority of loperamide early in the course of therapy appeared to be related to a loading-dose effect and not to any differences in antidiarrheal properties.
Asunto(s)
Antidiarreicos/uso terapéutico , Bencimidazoles/uso terapéutico , Calmodulina/antagonistas & inhibidores , Diarrea/tratamiento farmacológico , Loperamida/uso terapéutico , Enfermedad Aguda , Adulto , Bacterias/aislamiento & purificación , Diarrea/microbiología , Método Doble Ciego , Heces/microbiología , Femenino , Humanos , Masculino , México , Viaje , Resultado del TratamientoRESUMEN
Plasmid DNA analysis and antibiotic susceptibilities were used to study strains of Shigella sonnei isolated from U.S. travelers to Guadalajara, Mexico, over a period of seven years (1986 to 1992). One hundred sixty-one isolates were analyzed. By the use of cluster analysis, eight different plasmid profiles were identified during this interval. At any point in time, three to seven different plasmid profiles were present in this population. The introduction of strains that carried a new plasmid with a molecular mass of 5.1 MDa was coincidental with an increase in isolation of S. sonnei in 1988. This new plasmid was present in 87.5% of the isolates that were resistant to chloramphenicol. Shigellosis in Guadalajara follows a pattern of hyperendemic transmission with transient peaks of high-frequency isolation of S. sonnei. This pattern results from the concurrent presence of a heterogeneous group of strains as opposed to the widespread transmission of one or a few clones.
Asunto(s)
Diarrea/microbiología , Shigella sonnei/aislamiento & purificación , Viaje , Humanos , México , Pruebas de Sensibilidad Microbiana , Plásmidos , Shigella sonnei/efectos de los fármacos , Estudiantes , Factores de TiempoRESUMEN
Bacterial isolates obtained from fecal cultures of U.S. adults in Guadalajara, Mexico, with diarrhea developing during the summers of 1987, 1988, and 1989 were tested for in vitro antimicrobial susceptibility. No resistance was seen among 220 enterotoxigenic Escherichia coli isolates nor among 89 Shigella strains to aztreonam, norfloxacin, ciprofloxacin, gentamicin, or furazolidone. High level (greater than 1000 micrograms/ml) resistance to trimethoprim/sulfamethoxazole (TMP/SMX) was found in 7% of E. coli and 3% of Shigella strains. Susceptibility patterns of 27 E. coli strains derived from fecal cultures of Mexican infants in Guadalajara with diarrhea during the same time period showed similar results, possibly reflecting the presence of a common microbial reservoir. The study serves as a baseline for newer antimicrobials (fluoroquinolones and aztreonam) where no resistance is currently seen and provides evidence of the continuing value of TMP/SMX for therapy of diarrhea among travelers to Gudalajara and perhaps other areas of Mexico.
Asunto(s)
Diarrea/microbiología , Disentería Bacilar/tratamiento farmacológico , Infecciones por Escherichia coli/tratamiento farmacológico , Sulfametoxazol/uso terapéutico , Trimetoprim/uso terapéutico , Farmacorresistencia Microbiana , Humanos , México , Resistencia al TrimetoprimRESUMEN
OBJECTIVE: To evaluate a poorly absorbed antimicrobial with in vitro activity against all major bacterial enteropathogens in oral therapy for bacterial diarrhea. DESIGN: One hundred ninety-one US students with diarrhea acquired in Mexico received 100 mg of aztreonam or matching placebo three times a day for 5 days. Stools were cultured for bacterial enteropathogens before and after therapy. SETTING: We studied US students who acquired diarrhea in Mexico (travelers' diarrhea) in view of the high frequency of bacterial agents in this setting. MAIN OUTCOME MEASURE: We examined time of clinical recovery, treatment failures, adverse experiences, and microbiologic eradication from stool of the etiologic agent in subjects randomized to receive aztreonam or placebo. RESULTS: Aztreonam reduced the average duration of diarrhea compared with the placebo: for all cases, by 40 hours (P much less than .01); for those with enterotoxigenic Escherichia coli diarrhea, by 50 hours (P less than .01); for those with shigellosis, by 90 hours (P, not significant [small sample size]); for all bacterial agents, by 57 hours (P much less than .01). Clinical failures during the 5 days of therapy were seen in six patients (6%) receiving aztreonam and 25 (27%) receiving placebo (P less than .01). Pathogen eradication occurred in 95% of those receiving aztreonam and in 70% of those receiving the placebo (P less than .01). All bacterial enteropathogens were susceptible in vitro to aztreonam. The drug was well tolerated. CONCLUSIONS: Oral aztreonam, which is poorly absorbed, was well tolerated and was an effective therapy for bacterial diarrhea in US adults in Mexico.
Asunto(s)
Aztreonam/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Diarrea/tratamiento farmacológico , Viaje , Administración Oral , Adolescente , Adulto , Aztreonam/administración & dosificación , Diarrea/microbiología , Método Doble Ciego , Femenino , Humanos , Masculino , México , Persona de Mediana EdadRESUMEN
Intestinal secretory IgA (sIgA) response or lack of response among adults in Mexico with diarrhea was used as an indicator of enteropathogenicity of Aeromonas species and Plesiomonas shigelloides. sIgA was extracted from stool specimens obtained at day of presentation and 5 days later. Total sIgA was standardized, and specific sIgA titer against the organism being shed by each patient was determined. Western blotting was used to determine which microbial antigens elicited an intestinal sIgA response. Of 12 subjects shedding Aeromonas sobria or Aeromonas hydrophila, 11 had a fourfold or greater sIgA titer rise against the infecting strain. Western blotting showed that somatic lipopolysaccharides were the immunodominant antigens. No sIgA titer rises were detected among two patients shedding Aeromonas caviae or in 14 shedding P. shigelloides. This study provides further evidence of the significance of A. sobria and A. hydrophila as pathogens in acute diarrhea but raises additional questions about the role of P. shigelloides, at least in US adults with travelers' diarrhea.
Asunto(s)
Aeromonas/inmunología , Infecciones por Bacterias Gramnegativas/inmunología , Inmunoglobulina A Secretora/biosíntesis , Intestinos/inmunología , Plesiomonas/inmunología , Adulto , Anticuerpos Antibacterianos/biosíntesis , Western Blotting , Diarrea/inmunología , Diarrea/microbiología , Humanos , Lipopolisacáridos/inmunología , México , Estudiantes , Estados Unidos/etnologíaRESUMEN
Norwalk virus infection was sought in 48 US, 49 Puerto Rican, and 27 Mexican adults attending medical school in Guadalajara (Mexico) who were enrolled in a 2-year longitudinal study. Serum specimens were collected quarterly and as acute- and convalescent-phase samples around episodes of gastroenteritis. The reciprocal Norwalk virus geometric mean titer (GMT) for Puerto Rican students (567) was significantly higher than that of the US students overall (294; P less than .001) and for four of nine quarterly periods. The reciprocal Norwalk GMT for Mexican students (748) was also significantly higher than that of the US students overall (P less than .001) and for seven of nine quarterly periods. The average percentage of students per year with seroconversions was 30%. The rate of Norwalk virus infection averaged 0.36 episodes per student-year. Symptoms of gastroenteritis associated with seroconversion occurred in 45% of students. Preexisting serum antibody did not protect against subsequent Norwalk virus infection in these subjects. All student groups had similar rates of infection and symptomatic gastroenteritis.
Asunto(s)
Gastroenteritis/epidemiología , Virosis/epidemiología , Adulto , Anticuerpos Antivirales/sangre , Antígenos Virales/análisis , Antígenos Virales/sangre , Gastroenteritis/etnología , Humanos , Estudios Longitudinales , México/epidemiología , Virus Norwalk/inmunología , Puerto Rico/etnología , Estaciones del Año , Estados Unidos/etnología , Virosis/etnologíaRESUMEN
Fecal specimens from individuals traveling to Mexico were examined before, during, and after travel for the presence of Escherichia coli resistant to ampicillin, chloramphenicol, gentamicin, kanamycin, streptomycin, sulfonamides, trimethoprim (TMP), and TMP-sulfamethoxazole (TMP-SMX). None of these individuals took prophylactic antibiotics, although 4 of 13 took short courses of an antimicrobial agent for therapy of traveler's diarrhea. With an average of 9.3 E. coli per sample, resistance to all agents tested except gentamicin was shown to increase during the time in Mexico (P less than 0.001 to P less than 0.05). For example, no TMP-resistant (Tmpr) E. coli isolates were found by this method before travel, whereas 57% of the individuals had Tmpr and Tmpr-Smxr E. coli by the final week in Mexico. This increase in resistance occurred regardless of whether an individual took a short course of antimicrobial therapy. This study shows that travel itself, even without the use of prophylactic or therapeutic antimicrobial agents, is associated with the acquisition of resistant E. coli. Travel to developing nations may rival other sources of resistant organisms.
Asunto(s)
Antibacterianos/administración & dosificación , Diarrea/microbiología , Escherichia coli/aislamiento & purificación , Heces/microbiología , Viaje , Antibacterianos/uso terapéutico , Diarrea/prevención & control , Farmacorresistencia Microbiana , Escherichia coli/efectos de los fármacos , Humanos , MéxicoRESUMEN
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 traveler's diarrhea.
Asunto(s)
Diarrea/tratamiento farmacológico , Loperamida/uso terapéutico , Piperidinas/uso terapéutico , Viaje , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Adulto , Método Doble Ciego , Quimioterapia Combinada , Fluidoterapia , Humanos , Loperamida/administración & dosificación , México , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto , Combinación Trimetoprim y Sulfametoxazol/administración & dosificación , Estados Unidos/etnologíaRESUMEN
During the months of July 1977 and July 1985, students from the United States participated in a double-blind, placebo-controlled trial examining the effectiveness of liquid bismuth subsalicylate (BSS) (1977) and two dosages of the tablet formulation of BSS (1985) in preventing diarrhea while in Guadalajara, Mexico. In the first study, 62 subjects received BSS for 3 weeks at a dosage of 60 mL four times daily (4.2 g of BSS/d) compared with 66 students receiving an oral placebo at a similar dosage schedule. In the second study, 51 students took two tablets four times daily (2.1 g of BSS/d), 63 took one tablet four times daily (1.05 g of BSS/d), and 58 took a placebo (two tablets taken four times daily), each for 3 weeks. In the initial study, 14 (23%) BSS-treated subjects developed diarrhea compared with 40 (61%) placebo-tested persons (P less than .0001). In the second trial, seven (14%) subjects taking two tablets of BSS four times daily, 15 (24%) taking one tablet of BSS four times daily, and 23 (40%) receiving placebo tablets experienced diarrhea (P less than .001 for the higher dose). The percent protection provided by BSS was 62% for the group that received 4.2 g/d, 65% for 2.1 g/d, and 40% for 1.05 g/d, when compared with the corresponding placebo group. In cases in which stools were analyzed, seven (24%) of 29 BSS-treated subjects who had diarrhea had a detectable enteric pathogen, compared with 35 (59%) of 59 of those randomized to receive a placebo. BSS was well tolerated.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Bismuto/uso terapéutico , Diarrea/prevención & control , Compuestos Organometálicos/uso terapéutico , Salicilatos/uso terapéutico , Adulto , Bismuto/efectos adversos , Método Doble Ciego , Femenino , Humanos , Masculino , México , Compuestos Organometálicos/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Salicilatos/efectos adversos , Viaje , Estados UnidosRESUMEN
The goals of this study were threefold: to compare the etiology of travelers' diarrhea in West Africa and Mexico, to evaluate two fecal transport systems for the recovery of enteropathogens, and to verify the efficacy of liquid bismuth subsalicylate (BSS) in different locations and under different entrance criteria for disease severity. The study populations consisted of 133 European tourists in West Africa and 112 American students in Mexico who had suffered from travelers' diarrhea. In 60% and 38% of the stool samples at the two study sites, similar proportions of enteropathogens were detected. A two-vial system consisting of Enteric Plus medium and polyvinyl alcohol fixative was slightly superior for identifying enteric pathogens than was a three-vial system with buffered glycerol saline, Cary-Blair medium with campylobacter antibodies, and polyvinyl alcohol fixative. In a parallel, double-blind, randomized trial, BSS significantly shortened disease duration at both study sites.
Asunto(s)
Diarrea , Heces , Compuestos Organometálicos/uso terapéutico , Salicilatos/uso terapéutico , Viaje , Aeromonas/aislamiento & purificación , África Occidental , Animales , Bismuto , Cryptosporidium/aislamiento & purificación , Diarrea/tratamiento farmacológico , Diarrea/etiología , Diarrea/microbiología , Entamoeba histolytica/aislamiento & purificación , Escherichia coli/aislamiento & purificación , Heces/microbiología , Heces/parasitología , Femenino , Giardia/aislamiento & purificación , Humanos , Masculino , México , Shigella/aislamiento & purificación , Manejo de Especímenes/instrumentaciónRESUMEN
To better define the role of antimicrobial therapy among U.S. travelers in Mexico, clinical and nonculture laboratory parameters were compared for 56 patients with shigellosis and 204 others with diarrhea of other causes. The presence of fever, stool mucus and blood, and fecal leukocytes were significantly more common among patients with shigellosis (p less than 0.001) who also tended not to present with mild diarrhea (p less than 0.05). However, clinical and laboratory parameters were either too insensitive or too nonspecific to be useful in identifying most cases of shigellosis or in excluding the likelihood of its presence. Patients with mild clinical presentations, regardless of etiology, experienced resolution of disease sooner than those with moderate to severe presentations (p less than 0.01), but withholding therapy from patients with mild presentations resulted in 48% of these patients remaining ill at the end of 48 hours. Based on these findings, the authors advise empiric use of antimicrobial agents in travelers with diarrhea associated with fever, bloody stools, or fecal leukocytes, and for all travelers with moderate and severe diarrhea. If therapy is withheld from patients with initially mild presentations, a proportion might still require therapy, possibly an antimicrobial agent, for optimal control of symptoms.
Asunto(s)
Diarrea/etiología , Viaje , Diarrea/tratamiento farmacológico , Disentería Bacilar/diagnóstico , Disentería Bacilar/tratamiento farmacológico , Infecciones por Escherichia coli/diagnóstico , Infecciones por Escherichia coli/tratamiento farmacológico , Humanos , México , Estados UnidosRESUMEN
Within 48 hours of arrival in Mexico, 182 US students participated in a study to compare the efficacy of two dosages of bismuth subsalicylate (262 mg per tablet) as a prophylactic agent against diarrhea. The students were randomly assigned to receive two tablets (high dose) or one tablet (low dose) of bismuth subsalicylate four times daily or a placebo four times daily during a three-week period. Among these completing the trial, diarrhea (four or more unformed stools in 24 hours or three in eight hours, plus one other symptom) occurred in seven (14%) of 51 receiving the high-dose regimen compared with 15 (24%) of 63 receiving the low-dose regimen and 23 (40%) of 58 in the placebo group. Protection rates were 65% for high-dose and 40% for low-dose bismuth subsalicylate. Diarrhea caused by enterotoxigenic Escherichia coli was found in one student receiving the high-dose regimen, in no students receiving the low-dose regimen, and in seven placebo-treated subjects. Bismuth subsalicylate was well tolerated; the most common side effects were blackening of tongues and stools. Bismuth subsalicylate use in both dosages was associated with tinnitus at a low, clinically insignificant frequency of 1.2 days per 100 days of treatment. The dosage of two tablets of bismuth subsalicylate four times daily (2.1 g/d) appears to be a safe and effective means of reducing the occurrence of travelers' diarrhea among persons at risk for periods up to three weeks.
Asunto(s)
Bismuto , Diarrea/prevención & control , Compuestos Organometálicos/uso terapéutico , Salicilatos/uso terapéutico , Viaje , Adulto , Diarrea/microbiología , Humanos , México , Compuestos Organometálicos/administración & dosificación , Compuestos Organometálicos/efectos adversos , Probabilidad , Distribución Aleatoria , Salicilatos/administración & dosificación , Salicilatos/efectos adversos , ComprimidosRESUMEN
The efficacy of BW942C, a novel enkephalinlike pentapeptide antidiarrheal agent, was compared with the efficacy of trimethoprim-sulfamethoxazole (TMP-SMX) and the combination of the two agents in a placebo-controlled trial of the 72-h treatment of acute diarrhea. Subjects with diarrhea but without bloody stools or fever greater than 102 degrees F (38.9 degrees C) were enrolled. Administered to 134 U.S. adults with diarrhea that developed shortly after their arrival in Guadalajara, Mexico, BW942C was more efficacious than TMP-SMX in relieving diarrhea and cramps in the first 12 h of therapy, especially among subjects with diarrhea caused by enterotoxigenic E. coli. In the BW942C treatment group, 25% of subjects eventually took additional therapy because their diarrhea did not respond to BW942C alone. Neurological side effects such as dizziness and light-headedness occurred more frequently among BW942C-treated subjects. Therapy for 3 days with TMP-SMX provided lasting relief comparable with previously reported 5-day therapy. Use of the combination of both agents provided the benefits of prompt relief afforded by BW942C and lasting relief afforded by TMP-SMX. BW942C might prove to be an agent suitable for the treatment of acute diarrhea, with TMP-SMX reserved for treatment of those who do not respond adequately. The empiric use of the combination of BW942C and TMP-SMX appears appropriate for the treatment of severe nondysenteric disease.