Azithromycin, levofloxacin, rifaximin all effective for travelers diarrhea

Written by Dr. Kamal Kant Kohli Kohli Published On 2017-10-26T19:25:26+05:30 | Updated On 26 Oct 2017 7:25 PM IST

Three single-dose antibiotic regimens azithromycin, rifaximin and levofloxacin were all comparable for treating travelers’ diarrhea when paired with loperamide, according to findings recently published in Clinical Infectious Diseases.

Travelers’ diarrhea affects anywhere from 10% to 40% of short-term international travelers and recommended treatment for it includes the combination of an antibiotic, usually a fluoroquinolone or azithromycin, and loperamide for rapid resolution of symptoms. However, adverse events, postdose nausea with high-dose azithromycin, effectiveness of single-dose rifaximin, and emerging resistance to front-line agents are evidence gaps underlying current recommendations.

The researchers performed a randomized, double-blind controlled trial of U.S. and U.K. military service members in Afghanistan, Djibouti, Kenya and Honduras from September 2012 to July 2015. All patients had acute watery diarrhea and were randomly assigned to treatment with either single-dose azithromycin (500 mg; n = 106), levofloxacin (500 mg; n = 111) or rifaximin (1,650 mg; n = 107), all of which were paired with loperamide. The main outcomes were time to patients’ last unformed stool and clinical cure at 24 hours.It was found that clinical cure at 24 hours occurred in 81.4%, 78.3%, and 74.8% of the levofloxacin, azithromycin, and rifaximin arms, respectively. Compared with levofloxacin, azithromycin was not inferior (P = .01). Noninferiority could not be shown with rifaximin (P = .07). At 48 and 72 hours, efficacy among regimens was equivalent (approximately 91% at 48 and 96% at 72 hours). The median time to last unformed stool did not differ between treatment arms (azithromycin, 3.8 hours; levofloxacin, 6.4 hours; rifaximin, 5.6 hours). Treatment failures were uncommon (3.8%, 4.4%, and 1.9% in azithromycin, levofloxacin, and rifaximin arms, respectively) (P = .55). There were no differences between treatment arms with postdose nausea, vomiting, or other adverse events.

It was concluded that Single-dose azithromycin, levofloxacin, and rifaximin with loperamide were comparable for treatment of acute watery diarrhea."Overall, our findings provide strong evidence that loperamide-adjuncted, single-dose antibiotic therapy for [acute watery diarrhea] among travelers is safe and highly effective,” the researchers wrote. “Furthermore, these results highlight rapid clinically relevant improvement of illness and diarrheal symptoms associated with combination therapy.”

For further reading log on to:

Clinical Infectious Diseases, cix693, https://doi.org/10.1093/cid/cix693

Clinical Infectious Diseasesdiarrhealevofloxacinrifaximin

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Dr. Kamal Kant Kohli Kohli