Naval Medical Research Center, Silver Spring, Maryland.
Academic Department of Military Medicine, Royal Centre for Defence Medicine, Birmingham, United Kingdom.
Clin Infect Dis. 2017 Nov 29;65(12):2008-2017. doi: 10.1093/cid/cix693.
Recommended treatment for travelers' diarrhea 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.
A randomized, double-blind trial was conducted in 4 countries (Afghanistan, Djibouti, Kenya, and Honduras) between September 2012 and July 2015. US and UK service members with acute watery diarrhea were randomized and received single-dose azithromycin (500 mg; 106 persons), levofloxacin (500 mg; 111 persons), or rifaximin (1650 mg; 107 persons), in combination with loperamide (labeled dosing). The efficacy outcomes included clinical cure at 24 hours and time to last unformed stool.
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.
Single-dose azithromycin, levofloxacin, and rifaximin with loperamide were comparable for treatment of acute watery diarrhea.
NCT01618591.
旅行者腹泻的推荐治疗方法包括抗生素联合洛哌丁胺，通常是氟喹诺酮类或阿奇霉素，以迅速缓解症状。然而，不良反应、高剂量阿奇霉素用药后恶心、单剂量利福昔明的有效性以及一线药物的耐药性，这些都是当前推荐的证据空白。
2012 年 9 月至 2015 年 7 月在 4 个国家（阿富汗、吉布提、肯尼亚和洪都拉斯）进行了一项随机、双盲试验。患有急性水样腹泻的美国和英国军人被随机分为接受单剂量阿奇霉素（500mg；106 人）、左氧氟沙星（500mg；111 人）或利福昔明（1650mg；107 人），联合洛哌丁胺（标签剂量）。疗效终点包括 24 小时临床治愈率和最后一次未成形粪便时间。
24 小时临床治愈率分别为左氧氟沙星组 81.4%、阿奇霉素组 78.3%和利福昔明组 74.8%。与左氧氟沙星相比，阿奇霉素并不差（P=0.01）。不能证明利福昔明具有非劣效性（P=0.07）。在 48 小时和 72 小时时，方案之间的疗效相当（48 小时时约为 91%，72 小时时为 96%）。治疗组之间最后一次未成形粪便的时间中位数无差异（阿奇霉素组 3.8 小时；左氧氟沙星组 6.4 小时；利福昔明组 5.6 小时）。治疗失败的情况并不常见（阿奇霉素组、左氧氟沙星组和利福昔明组分别为 3.8%、4.4%和 1.9%）（P=0.55）。用药后恶心、呕吐或其他不良反应在各组之间无差异。
单剂量阿奇霉素、左氧氟沙星和利福昔明联合洛哌丁胺治疗急性水样腹泻的疗效相当。
NCT01618591。
