B Swetha, Satish Kumar Rajappan Chandra, B Mothishwaran, C K Kripa Shankar
Department of Pharmacy Practice, SRM Institute of Science and Technology, Chennai, IND.
Clinical Trial and Research Unit, Interdisciplinary Institute of Indian System of Medicine, SRM Institute of Science and Technology, Chennai, IND.
Cureus. 2024 Sep 25;16(9):e70213. doi: 10.7759/cureus.70213. eCollection 2024 Sep.
Diarrhea is a common illness for travelers. Traveler's diarrhea is typically defined as experiencing at least three unformed stools per day during a stay abroad or within 10 days of returning from the destination. In this review, we consulted five databases, namely, Medicine Complete, Medscape, Drugs.com, Epocrates, and DDInter, to conduct a comprehensive drug interaction analysis. We selected commonly prescribed medications used for the treatment of traveler's diarrhea, including ciprofloxacin, levofloxacin, norfloxacin, ofloxacin, azithromycin, rifaximin, bismuth salicylate, and loperamide. The antidiabetic medications chosen included metformin, glipizide, glimepiride, sitagliptin, linagliptin, dapagliflozin, empagliflozin, and acarbose. The chosen antihypertensive drugs were telmisartan, olmesartan, amlodipine, nifedipine, enalapril, ramipril, metoprolol, and propranolol. Aspirin, clopidogrel, ticagrelor, rivaroxaban, warfarin, atorvastatin, and rosuvastatin were also chosen as they play an essential role in cardiovascular treatment. We performed comprehensive interaction checks across all five databases for each combination of a traveler's diarrhea medication and medication from one of the three comorbid conditions (antidiabetic, antihypertensive, or cardioprotective). We categorized the severity of interactions as mild, moderate, or severe. Similarly, we used colors to highlight the number of databases reporting drug interactions, providing insights into the reliability of these interactions across sources. Interactions with antidiabetic drugs revealed that fluoroquinolones and sulfonylureas produce severe interaction effects. Comparatively, rifaximin can be safer as it exhibited mild interaction only with metformin, whereas the other antidiabetic drugs showed no interaction effect. Levofloxacin was found to be the safest drug among hypertensive individuals as it exerted no interaction effects with any of the antihypertensive medications. Levofloxacin and rifaximin were considered to be safe as these drugs interacted with only two cardioprotective drugs. This review features the importance of a precise approach in prescribing medications for traveler's diarrhea, especially for patients with chronic comorbidities. These findings play a pivotal role in improving awareness and providing tailored treatment for the interaction to ensure patient well-being.
腹泻是旅行者的常见疾病。旅行者腹泻通常定义为在国外停留期间或从目的地返回后10天内，每天至少出现三次不成形大便。在本综述中，我们查阅了五个数据库，即Medicine Complete、Medscape、Drugs.com、Epocrates和DDInter，以进行全面的药物相互作用分析。我们选择了常用于治疗旅行者腹泻的药物，包括环丙沙星、左氧氟沙星、诺氟沙星、氧氟沙星、阿奇霉素、利福昔明、水杨酸铋和洛哌丁胺。所选的抗糖尿病药物包括二甲双胍、格列吡嗪、格列美脲、西他列汀、利格列汀、达格列净、恩格列净和阿卡波糖。所选的降压药物有替米沙坦、奥美沙坦、氨氯地平、硝苯地平、依那普利、雷米普利、美托洛尔和普萘洛尔。阿司匹林、氯吡格雷、替格瑞洛、利伐沙班、华法林、阿托伐他汀和瑞舒伐他汀也被选中，因为它们在心血管治疗中起着重要作用。我们针对旅行者腹泻药物与三种合并症（抗糖尿病、抗高血压或心脏保护）之一的药物的每种组合，在所有五个数据库中进行了全面的相互作用检查。我们将相互作用的严重程度分为轻度、中度或重度。同样，我们用颜色突出显示报告药物相互作用的数据库数量，以深入了解这些相互作用在不同来源之间的可靠性。与抗糖尿病药物的相互作用表明，氟喹诺酮类药物和磺脲类药物会产生严重的相互作用效应。相比之下，利福昔明可能更安全，因为它仅与二甲双胍表现出轻度相互作用，而其他抗糖尿病药物未显示相互作用效应。在高血压患者中，左氧氟沙星被发现是最安全的药物，因为它与任何一种降压药物均无相互作用。左氧氟沙星和利福昔明被认为是安全的，因为这些药物仅与两种心脏保护药物相互作用。本综述强调了在为旅行者腹泻开处方时采用精确方法的重要性，特别是对于患有慢性合并症的患者。这些发现对于提高认识和提供针对相互作用的个性化治疗以确保患者健康起着关键作用。
