salicylates and Dysentery--Bacillary

Various available forms of therapy can decrease morbidity and mortality associated with acute diarrhea. Oral fluids represent the cornerstone of therapy of all cases. A variety of agents acting nonspecifically can decrease diarrhea and improve other worrisome symptoms associated with enteric infection. Kaopectate makes the stool more formed but has little additional effects. Bismuth subsalicylate, an antisecretory agent, reduces the number of stools passed by about 50 percent and improves other associated symptomatology. The drugs that affect motility such as loperamide and diphenoxylate are the most active of the nonspecifically acting drugs. They must be avoided in patients with significant fever and dysentery. Trimethoprim/sulfamethoxazole is now considered the drug of choice for shigellosis due to the presence of ampicillin-resistant Shigella strains in most regions of the world. Trimethoprim/sulfamethoxazole is also an effective form of therapy for enterotoxigenic Escherichia coli infection and for traveler's diarrhea without definable cause. Erythromycin, although not proved to be effective against Campylobacter, probably shortens the disease. Furazolidone, although not dramatically effective, has a spectrum of activity that includes Shigella, enterotoxigenic E. coli, Campylobacter, and Giardia lamblia. It may not be effective in severely ill (hospitalized) patients with diarrhea. The various forms of available therapy can be administered empirically, depending on symptomatology. Mildly ill patients (one to three unformed stools in 24 hours with minimal additional symptoms) probably are best treated with fluids only. Mild to moderately ill persons (three to six unformed stools in 24 hours) can be treated with a drug that acts nonspecifically, such as bismuth subsalicylate or loperamide. Those with severe diseases (six or more unformed stools with moderate to severe associated symptoms), particularly when associated with fever and the passage of bloody mucoid stools, may be given an antimicrobial agent. The antimicrobial drug given will be determined by ancillary laboratory tests (dark-field examination or examination of a wet-mount preparation for motile Campylobacter or stool culture for Shigella, Campylobacter, or Salmonella) or may be administered on an empiric basis. Traveler's diarrhea can be eliminated in selected persons by the administration of a pharmacologic agent. Liquid bismuth subsalicylate is effective in large doses, which may be impr

Topics: Acute Disease; Adult; Anti-Infective Agents; Bismuth; Campylobacter Infections; Child; Child, Preschool; Clinical Trials as Topic; Diarrhea; Diarrhea, Infantile; Drug Combinations; Dysentery, Amebic; Dysentery, Bacillary; Escherichia coli Infections; Giardiasis; Humans; Infant; Kaolin; Loperamide; Narcotics; Organometallic Compounds; Parasympatholytics; Pectins; Salicylates; Salmonella Infections; Travel

Three hundred million people, mostly tourists, participate in international travel each year. Development of an acute diarrheal syndrome abroad, while returning home, or shortly after arriving home is referred to as traveler's diarrhea (TD). TD is not a specific diagnosis but, rather, a clinical syndrome with multiple etiologies. In this article, clinical and epidemiological features of TD, specific etiologies and their pathogenesis, as well as current means of diagnosis, treatment, and prevention will be reviewed.

Topics: Anti-Bacterial Agents; Antidiarrheals; Bismuth; Campylobacter Infections; Diarrhea; Diet; Dysentery, Bacillary; Escherichia coli Infections; Fluid Therapy; Giardiasis; Humans; Intestines; Organometallic Compounds; Risk; Salicylates; Salmonella Infections; Time Factors; Travel; Vaccination; Vibrio Infections; Vibrio parahaemolyticus

Topics: Antimetabolites; Arthritis, Reactive; Chlamydia; Chlamydia Infections; Dysentery, Bacillary; Female; Hepatitis B Antigens; Herpesviridae Infections; Humans; Indomethacin; Leukocyte Count; Male; Mycoplasma; Mycoplasma Infections; Phenylbutazone; Prognosis; Salicylates; Salmonella Infections; Sexually Transmitted Diseases; Shigella; Synovial Fluid

Various available forms of therapy can decrease morbidity and mortality associated with acute diarrhea. Oral fluids represent the cornerstone of therapy of all cases. A variety of agents acting nonspecifically can decrease diarrhea and improve other worrisome symptoms associated with enteric infection. Kaopectate makes the stool more formed but has little additional effects. Bismuth subsalicylate, an antisecretory agent, reduces the number of stools passed by about 50 percent and improves other associated symptomatology. The drugs that affect motility such as loperamide and diphenoxylate are the most active of the nonspecifically acting drugs. They must be avoided in patients with significant fever and dysentery. Trimethoprim/sulfamethoxazole is now considered the drug of choice for shigellosis due to the presence of ampicillin-resistant Shigella strains in most regions of the world. Trimethoprim/sulfamethoxazole is also an effective form of therapy for enterotoxigenic Escherichia coli infection and for traveler's diarrhea without definable cause. Erythromycin, although not proved to be effective against Campylobacter, probably shortens the disease. Furazolidone, although not dramatically effective, has a spectrum of activity that includes Shigella, enterotoxigenic E. coli, Campylobacter, and Giardia lamblia. It may not be effective in severely ill (hospitalized) patients with diarrhea. The various forms of available therapy can be administered empirically, depending on symptomatology. Mildly ill patients (one to three unformed stools in 24 hours with minimal additional symptoms) probably are best treated with fluids only. Mild to moderately ill persons (three to six unformed stools in 24 hours) can be treated with a drug that acts nonspecifically, such as bismuth subsalicylate or loperamide. Those with severe diseases (six or more unformed stools with moderate to severe associated symptoms), particularly when associated with fever and the passage of bloody mucoid stools, may be given an antimicrobial agent. The antimicrobial drug given will be determined by ancillary laboratory tests (dark-field examination or examination of a wet-mount preparation for motile Campylobacter or stool culture for Shigella, Campylobacter, or Salmonella) or may be administered on an empiric basis. Traveler's diarrhea can be eliminated in selected persons by the administration of a pharmacologic agent. Liquid bismuth subsalicylate is effective in large doses, which may be impr

Topics: Acute Disease; Adult; Anti-Infective Agents; Bismuth; Campylobacter Infections; Child; Child, Preschool; Clinical Trials as Topic; Diarrhea; Diarrhea, Infantile; Drug Combinations; Dysentery, Amebic; Dysentery, Bacillary; Escherichia coli Infections; Giardiasis; Humans; Infant; Kaolin; Loperamide; Narcotics; Organometallic Compounds; Parasympatholytics; Pectins; Salicylates; Salmonella Infections; Travel

Students attending a Mexican university who developed diarrhea were randomly treated with bismuth subsalicylate or a placebo. One hundred and eleven were given 30 ml each 1/2 hr until eight doses (total dose of active drug 4.2 g) were given and 58 students received twice this dose (8.2 g of active drug) over the 3 1/2-hr treatment period. The number of unformed stools was significantly decreased in both bismuth subsalicylate treatment groups compared to the placebo controls for the period 4 to 24 hr after therapy. A reduction in diarrhea was additionally noted for the duration of the 48-hr surveillance period for the students receiving the higher dose of active drug. Subjective relief within 24 hr of therapy of the symptoms of diarrhea, nausea, and abdominal pain or cramps was reported with a significantly increased frequency in the bismuth subsalicylate group. The most pronounced effect of the treatment occurred in the United States students with diarrhea who had recently arrived in Mexico. This appeared to be related to the favorable effect of bismut subsalicylate on the course of toxigenic Escherichia coli infection. Students with shigellosis did not experience a prolonged illness in either treatment group.

Topics: Bismuth; Clinical Trials as Topic; Diarrhea; Drug Combinations; Dysentery, Bacillary; Escherichia coli Infections; Humans; Mexico; Placebos; Salicylates; Students

The degree of discomfort and inconvenience caused by travelers' diarrhea highlights the need to prepare the international traveler thoroughly. In addition to observing food and water precautions, most travelers should carry antibiotics and antimotility agents to be started if diarrhea occurs. Used judiciously, these precautions may prevent an unplanned tour of bathrooms and outhouses in foreign countries.

Topics: Bismuth; Campylobacter jejuni; Diarrhea; Dysentery, Bacillary; Food Contamination; Giardiasis; Humans; Organometallic Compounds; Rotavirus Infections; Salicylates; Salmonella Infections; Sulfonamides; Travel