Department of Bacteriology and Immunology, University of Helsinki, P.O. Box 21, FI-00014, Finland; Inflammation Center, Division of Infectious Diseases, University of Helsinki and Helsinki University Hospital, P.O. Box 348, FI-00029, Finland.
Inflammation Center, Division of Infectious Diseases, University of Helsinki and Helsinki University Hospital, P.O. Box 348, FI-00029, Finland.
Travel Med Infect Dis. 2019 Jan-Feb;27:64-71. doi: 10.1016/j.tmaid.2018.06.007. Epub 2018 Jun 9.
As antibiotics predispose travelers to acquiring multidrug-resistant intestinal bacteria, they should no longer be considered a mainstay for treating travelers' diarrhea. It has been claimed that stand-by antibiotics are justified as a means to avoid visits to local healthcare providers which often lead to polypharmacy.
We revisited the traveler data of 316 prospectively recruited volunteers with travelers' diarrhea by retrieving from questionnaires and health diaries information on antibiotic use, stand-by antibiotic carriage, and visits with local healthcare. Multivariable analysis was applied to identify factors associated with antibiotic use.
Among our 316 volunteers with travelers' diarrhea, however, carrying stand-by antibiotics seemed not to reduce the rate of healthcare-seeking; on the contrary, antibiotic use was more frequent among stand-by antibiotic carriers (34%) than non-carriers (11%). Antibiotics were equally taken for severe and incapacitating travelers' diarrhea, but compared to non-carriers, stand-by antibiotic carriers resorted to medication also for mild/moderate (38% vs. 4%) and non-incapacitating disease (29% vs. 5%). Antibiotic use was associated with stand-by antibiotic carriage (OR 7.2; 95%CI 2.8-18.8), vomiting (OR 3.5; 95%CI 1.3-9.5), incapacitating diarrhea (OR 3.6; 95%CI 1.3-9.8), age (OR 1.03; 95%CI 1.00-1.05), and healthcare visit for diarrhea (OR 465.3; 95%CI 22.5-9633.6).
Carriage of stand-by antibiotics encouraged less cautious use of antibiotics. Recommendations involving prescription of antibiotics for all travelers require urgent revision.
由于抗生素会使旅行者更容易感染多药耐药性肠道细菌，因此它们不应再被视为治疗旅行者腹泻的主要药物。有人声称，备用抗生素是合理的，可以避免前往当地医疗机构就诊，因为这通常会导致多种药物联合使用。
我们通过检索问卷和健康日记中关于抗生素使用、备用抗生素携带和当地医疗保健就诊的信息，重新分析了 316 名前瞻性招募的旅行者腹泻志愿者的数据。采用多变量分析来确定与抗生素使用相关的因素。
然而，在我们的 316 名患有旅行者腹泻的志愿者中，携带备用抗生素似乎并没有降低寻求医疗保健的比率；相反，备用抗生素携带者（34%）比非携带者（11%）更频繁地使用抗生素。抗生素同样用于严重和使人丧失能力的旅行者腹泻，但与非携带者相比，备用抗生素携带者也会因轻度/中度（38%比 4%）和非使人丧失能力的疾病（29%比 5%）而使用药物。抗生素的使用与备用抗生素携带（OR 7.2；95%CI 2.8-18.8）、呕吐（OR 3.5；95%CI 1.3-9.5）、使人丧失能力的腹泻（OR 3.6；95%CI 1.3-9.8）、年龄（OR 1.03；95%CI 1.00-1.05）和因腹泻就诊（OR 465.3；95%CI 22.5-9633.6）有关。
携带备用抗生素鼓励更不谨慎地使用抗生素。需要紧急修订涉及为所有旅行者开具抗生素处方的建议。
