Академический Документы
Профессиональный Документы
Культура Документы
Brigitte Meuris
Background: European air travelers returning from Algeria, Egypt, Mexico, Morocco, and Tunisia were interviewed about
their experience of travelers diseases upon arrival in Brussels. Diarrhea was mentioned by 37% of the adults and 27%
of the children. These subjects were questioned about the types of measures taken, type and duration of drug treatment
(if any), and about duration of diarrhea and side effects experienced.
Methods: Final analysis was performed based on 2160 interviews. The largest proportion of diarrhea was reported in the
age group 15-24 years (46%).
Results:The majority of the 2160 subjects had opted for drug treatment (81%):927 subjects for loperamide alone, 235 for
loperamide in combination with nifuroxazide, and 178 for nifuroxazide alone. Other drugs had been used less frequently.
The median time t o recovery was 2.4 days with loperamide compared to 3.2 days with nifuroxazide and t o 3.4 days for
the no-treatment group.
Conclusions: A stratification of the results by severity of the diarrhea suggests a rank of antidiarrheal potency as follows: loperamide > nifuroxazide > no-drug treatment. The side effect with the highest incidence was constipation (2.4%
with loperamide). ( J Travel M e d 2:ll-15, 1995)
11
J o u r n a l o f T r a v e l M e d i c i n e , V o l u m e 2, N u m b e r 1
12
Adult
(n* = 5373) (
9
9
)
Child
(a = 818) (!A)
Table 2
Severity Class
Stool
Appearance
Stool
Frequency
Associated
Symptoms
(score*)
~~
Fever
Vomiting
Abdominal cramps
Common cold
Sore throat
Sunburn
Constipation
Diarrhea
Jaundice
Physical injury
Other complaints
No complaints
183
257
916
269
287
614
180
2000
2
86
125
2475
(3.4)
(4.8)
(17.0)
(5.0)
(5.3)
(11.4)
(3.4)
(37.2)
(0.04)
(1.6)
(2.3)
(46.1)
42 (5.1)
29 (3.5)
45 (5.5)
21 (2.6)
20 (2.4)
31 (3.8)
4 (0.5)
225 (27.5)
11 (1.3)
18 (2.2)
476 (58.2)
Mild
Loose
Moderate
Loose
Marked
Watery
Loose
Watery
Mucoid
Loose
Severe
Watery
Mucoid
Bloody
$2
52
3-5
$2
52
3-5
6-8
$2
3-5
52
3-5
6-8
>8
52
3-5
26
52
23
any frequency
$2
3
52
$2
4
3
52
3
$2
<2
4
23
$4
4
23
$4
23
$4
$4
Results
The total population of diarrhea sufferers consisted
of2000 adults and 225 &dren,The
oftravelers were returning fromTunisia (57%).Mexico had the
fewest visitors within this population (2%), followed by
Algeria (5%), Egypt (8%),and Morocco (26%). In 2%,
the site of embarkation was not registered.
Table 3 shows the age distribution in the diarrhea
population relative to the population interviewed.The
Table 3 Age Distribution of Diarrhea Sufferers Relative to
Population Interviewed
Age
(Y)
2-4
5-9
10-14
15-24
25-34
35-44
45-54
t 55
N o t evaluable
Traveler in
Each Age Group
(No.)
Diarrhea
Sufferers
(No.)
140
292
286
1791
1562
992
66 1
367
100
6191
35
72
90
831
581
313
218
56
29
2225
25
24.6
31.5
46.4
37.2
31.6
33
15.2
35.9
Me u r is, T r a v e l e r s D i a r r h e a
13
Treatment
Because 65 of the interviews of the 2225 diarrhea
sufferers were incomplete or inconsistent, only 2160
case reports could be used for the final analysis. O f the
2160 subjects who contributed useful data, the majority had chosen drug therapy (81%).Table 4 lists all treatment measures taken by the diarrhea population. This
drug-treated population was analyzed in detail, and more
specifically, attention was given to the more frequently
reported drug regimens, as mentioned above under the
heading Subjects and Methods.
The major drug treatments were the following: 927
subjects had used loperamide monotherapy; 235 had
used loperamide in combination with nifuroxazide; 178
Table 4
Measure
Change of diet
N o food intake
More liquid intake (e.g., rice water)
Stayed indoors
Drug treatment
Specialized care*
Other
No special measures
Number of subjects
Number of measurest
*Includes advice from general practitioners.
+Some subjects took more than one measure.
Number
204
57
103
28
1742
25
17
288
2160
2464
9.4
2.6
4.8
1.3
80.6
1.2
0.8
13.3
Miid
Moderate
Marked
Severe
Loperamide
Nifuroxazide
Loperamide plus
nifuroxazide
None
26
27
24
32
25
23
20
22
24
22
26
29
30
33
17
20
14
MODERATE DIARRHEA
MILD DIARRHEA
1
0.Q
0.Q
0.0
0.8
0.7
0.7
0.6
0.0 -
0.5
0.5
0.4
0.4
0.3
0.3-
0.2
0.2
0.1
/
1
.6
1.6
1 ,
,
2.6
/
/
/ ,
/
/
3.6
/
!
4.5
0.1 -
0 1 ,
/ ,
/ ,
/ ,
/ ,
/ ,
LIFETABLEANALYSIS
MARKED DIARRHEA
SEVERE DIARRHEA
1
0.9
0.0
0.7
0.0
0.5
0.4
0.4
0.3
,,I
V.0
0.2
0.1
0.1
0 1 ,
0
.6
1
1.6
2
2.5
3
3.6
4
NO. OF DAYS POST INITIATIONOF THERAPY
I
LOPERAMIDE
4.5
.6
LOPERAMIDE
NO MEDICATION
>
,!
1
1.6
2
2.5
3
3.6
4
NO. OF DAVS POST INITIATIONOF THERAPY
4.5
NO MEDICATION
LIFETABLEANALYSIS
LIFETABLEANALYSIS
Side Effects
T h e incidence of side effects was very low in this
drug-treated population.There were n o serious adverse
effects.The side effect with the highest incidence was
constipation, namely 2.6% and 1.7% with the loperamide monotherapy and with the combination of loperamide and nifuroxazide group respectively; this
Discussion
The prevalence of 37% diarrheal disease in the
group of travelers interviewed corresponds well with
the incidences reported elsewhere, including travel to
other destinations., In the present study, more adults
15
References
1 . Farthmg MJG, DuPont HL, Guandahni S, et al.Treatment and
prevention of travelers' darrhoea. Gastroenterology International 1992; 5:162-175.
DuPont HL, Ericsson CD. Prevention and treatment of travelers' diarrhea. N Engl J Med 1993; 328:1821-1827.
Dupont HL, Hornick RB.Adverse effect of Lomotil therapy in Shigellosis.JAMA 1973; 226:1525-1528.
Schultsz C, De Geus A. Characteristics and aetiology of diarrhoea in travelers returned from the (sub) tropics. Eur J
Intern Med 1992; 2:217-222.
5. Farthing MJG. Travelers' diarrhoea (Editorial). BMJ 1993;
306: 1425-1426.
6. Ruppin H. Review: Loperamide-a potent antidiarrhoeal
drug with actions along the alimentary tract. Aliment Pharmacol Ther 1987; 1:179-191.
7. Van Loon FPL, Bennish ML, Speelman P, Butler C. Doubleblind trial of loperamide for treating acute watery diarrhoea
in expatriates in Bangladesh. Gut 1989; 30:492-495.
8. Gascoigne EW, Reyntjens A, Huijghebaert S. World-wide
experience with loperamide in acute diarrhoea. In: Dupont
HL, ed. Acute infectious diarrhoea: role of drug therapy
Janssen Research Foundation, 1987:54-70.
9. Lambert-Zechovsky N, Cezard JP, Bingen E, et al. Effect of
loperamide on faecal flora in infants with severe protracted
dlarrhoea. In: Dupont HL, ed.Acute infectious dlarrhoea: role
of drug therapy. Janssen Research Foundation, 1987:44-52.
10. Steffen R, Heusser R, Helminger A, Schaer M. Preliminary
results of a controlled study on the efficacy and side-effects
of various agents in the therapy of traveler's diarrhoea. In:
Dupont HL, ed. Acute infectious diarrhoea: role of drug
therapy. Janssen Research Foundation, 1987:38-41.