Although trimethoprim-sulfamethoxazole is the standard treatment for traveler's diarrhea caused by bacterial infection, trimethoprim-resistant bacteria have been encountered in many areas of the world. The newer fluoroquinolones have been useful in adults infected with trimethoprim-resistant organisms, but these agents are not used in young children because of possible damage to growing articular cartilage. An antibiotic without major intestinal absorption theoretically would be associated with fewer adverse systemic effects and should be safe for use in children and possibly pregnant women. Oral aztreonam, a minimally absorbed monobactam antibiotic, demonstrates a high degree of activity in vitro against bacterial enteropathogens. DuPont and colleagues evaluated the effectiveness of aztreonam in the treatment of bacterial traveler's diarrhea.
A total of 191 Americans studying in Mexico were included in the study. All subjects had acute diarrhea and at least one of the following symptoms: pain or cramps, nausea, vomiting or fever. Patients were randomized to receive either 100 mg of aztreonam three times daily for five days (98 patients) or placebo (93 patients). Stool cultures and symptom diaries were used to assess outcome.
Patients receiving aztreonam improved more quickly than did patients receiving placebo: the average duration of diarrhea was 40 hours lower in patients given the antibiotic. Stool cultures after treatment showed that pathogens were more commonly eradicated in aztreonam-treated patients.
The authors conclude that aztreonam appears to be an effective treatment for bacterial traveler's diarrhea and is well tolerated by most patients. (JAMA, April 8, 1992, vol. 267, p. 1932.)
COPYRIGHT 1992 American Academy of Family Physicians
COPYRIGHT 2004 Gale Group
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