Abstract
Bacterial enteropathogens are responsible for between 40 % and 80 % of diarrheal illness depending upon the age of the persons affected and geographic area where illness occurs. Antibacterial agents will shorten the illness associated with enteric infection caused by enterotoxigenicEscherichia coli, Shigella spp. andCampylobacter jejuni. These drugs also are effective in the therapy of certain clinical conditions (presumably because they are due to the same agents) which are characterized by moderate to severe diarrhea with one or more of the following: high fever, dysentery (passage of bloody mucoid stools), or high leukocyte counts in stools. Antimicrobial agents are also effective in the therapy of travelers' diarrhea. The quinolone drugs have several advantages in the management of bacterial diarrhea where strains causing illness from nearly all regions of the world will show general susceptibility: high concentrations are achieved in the intestinal lumen following oral administration and resistance development is unusual. A quinolone probably represents the optimal agent for therapy of bacterial diarrhea in adults in areas where trimethoprim-resistant enteric pathogens are common.
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DuPont HL, Pickering LK Infections of the gastro-intestinal tract: microbiology, pathophysiology, and clinical features. Plenum, New York, 1980.
Shukry S, Zaki AM, DuPont HL, Shoukry I, El Tagy M, Hamed Z Detection of enteropathogens in fatal and potentially fatal diarrhea in Cairo, Egypt. Journal of Clinical Microbiology 1986, 24: 959–962.
Carlson JR, Thornton SA, DuPont HL, West AH, Mathewson, JJ Comparative in vitro activities of ten antimicrobial agents against bacterial enteropathogens. Antimicrobial Agents and Chemotherapy 1983, 24: 509–513.
Murray BE Resistance ofShigella, Salmonella, and other selected enteric pathogens to antimicrobial agents. Reviews of Infectious Diseases 1986, 8, Supplement 2: 172–181.
Shangu DL, Weinberg E, Gadebusch HH In vitro antibacterial activity of norfloxacin (MK-0366, AM-715) and other agents against gastrointestinal tract pathogens. Antimicrobial Agents and Chemotherapy 1983, 23: 86–90.
Goodman LJ, Fliegelman RM, Trenholme GM, Kaplan RL Comparative in vitro activity of ciprofloxacin againstCampylobacter spp. and other bacterial enteric pathogens. Antimicrobial Agents and Chemotherapy 1984, 25: 504–506.
Goosens H, De Mol P, Coignau H, Levy J, Grados O, Ghysels G, Habyaremye I, Butzler J Comparative in vitro activities of aztreonam, ciprofloxacin, norfloxacin, ofloxacin, HR810 (a new cephalosporin), RU 28965 (a new macrolide), and other agents against enteropathogens. Antimicrobial Agents and Chemotherapy 1985, 27: 388–392.
Morris JG, Tenny JH, Drusano GL In vitro susceptibility of pathogenicVibrio species to norfloxacin and six other antimicrobial agents. Antimicrobial Agents and Chemotherapy 1985, 28: 442–445.
O'Hare MD, Flemingham D, Ridgway GL, Grüneberg RN The comparative in vitro activity of twelve 4-quinolone antimicrobials against enteric pathogens. Drugs in Experimental and Clinical Research 1985, 11: 253–257.
San Joaquin VH, Scribner RK, Pickett DA, Welch DF Antimicrobial susceptibility ofAeromonas species isolated from patients with diarrhea. Antimicrobial Agents and Chemotherapy 1986, 30: 794–795.
Vanhoof R, Hubrechts JM, Rocbben E, Nyssen HJ, Nulens E, Leger J, DeSchepper N The comparative activity of pefloxacin, enoxacin, ciprofloxacin and 13 other antimicrobial agents against enteropathogenic microorganisms. Infection 1986, 14: 294–298.
Ling J, Kam KM, Lam AW, French GL Susceptibilities of Hong Kong isolates of multiply resistantShigella spp. to 25 antimicrobial agents, including ampicillin plus sulbactam and new 4-quinolones. Antimicrobial Agents and Chemotherapy 1988, 30: 20–23.
Burman LG Apparent absence of transferable resistance to nalidixic acid in pathogenic gram-negative bacteria. Journal of Antimicrobial Chemotherapy 1977, 3: 509–516.
Neu HC, Labthavikul P In vitro activity of norfloxacin, a quinoline carboxylic acid, compared with that of β-lactams, aminoglycosides, and trimethoprim. Antimicrobial Agents and Chemotherapy 1982, 22: 23–27.
Areieri G, Griffith E, Gruenwaldt G, Heyd A, O'Brien B, Beeker N, August R Ciprofloxacin: an update on clinical experience. American Journal of Medicine 1987, 82, Supplement 4A: 381–386.
Altwegg M, Burnens A, Zollinger-Iten J, Penner JL Problems in identification ofCampylobacter jejuni associated with acquisition of resistance to nalidixic acid. Journal of Clinical Microbiology 1987, 25: 1807–1808.
Cofsky RD, DuBouchet L, Landesman SH Recovery of norfloxacin in feces after administration of a single oral dose to human volunteers. Antimicrobial Agents and Chemotherapy 1984, 26: 110–116.
Brumfitt W, Franklin I, Grady D, Hamilton-Miller JMT, Iliffe A Changes in the pharmacokinetics of ciprofloxacin and fecal flora during administration of a 7-day course to human volunteers. Antimicrobial Agents and Chemotherapy 1984, 26: 757–761.
Ericsson CD, DuPont HL, Sullivan P, Galindo E, Evans DG, Evans DJ Bicozamycin, a poorly absorbable antibiotic, effectively treats traveler's diarrhea. Annals of Internal Medicine 1983, 98: 20–25.
Oberhelman RA, de la Cabada FJ, Garibay EV, Bitsura JM, DuPont HL Efficacy of trimethoprim/sulfamethoxazole in the treatment of acute diarrhea in a Mexican pediatric population. Journal of Pediatrics 1987, 110: 960–965.
DuPont HL, Reves RR, Galindo E, Sullivan PS, Wood LV, Mendiola JG Treatment of travelers' diarrhea with trimethoprim/sulfamethoxazole and with trimethoprim alone. New England Journal of Medicine 1982, 307: 841–844.
Ericsson CD, Johnson PC, DuPont HL, Morgan DR, Bitsura JA, Cabada FJ Ciprofloxacin or trimethoprim-sulfamethoxazole as initial therapy for traveler's diarrhea. Annals of Internal Medicine 1987, 106: 216–220.
DuPont HL, Corrado ML, Sabbaj J Use of norfloxacin in the treatment of acute diarrheal disease. American Journal of Medicine 1987, Supplement 6B: 79–83.
DuPont HL, Ericsson CD, Mathewson JJ, Johnson PC, DuPont MW Prevention and treatment of travelers' diarrhea. International Congress for Infectious Diseases, Montreal, 1990, Abstract.
Nelson JD, Kusmiesz H, Jackson LH, Woodman E Trimethoprim/sulfamethoxazole therapy for shigellosis. Journal of the American Medical Association 1976, 235: 1239–1243.
Gross RJ, Threlfall EJ, Ward LR, Rowe B Drug resistance inShigella dysenteriae, S. flexneri andS. boydii in England and Wales: increasing incidence of resistance to trimethoprim. British Medical Journal 1984, 288: 784–786.
Rogerie F, Ott D, Vandepitte J, Verbist L, Lemmens P, Habiyaremye I Comparison of norfloxacin and nalidixic acid for treatment of dysentery caused byShigella dysenteriae type 1 in adults. Antimicrobial Agents and Chemotherapy 1986, 29: 883–886.
Lewis MJ Multiple transmissible drug resistance in an outbreak ofShigella flexneri infection. Lancet 1967, ii: 953–956.
Hansson HB, Barkenius G, Cronberg S, Juhlin I Controlled comparison of nalidixic acid or lactulose with placebo in shigellosis. Scandinavian Journal of Infectious Diseases 1981, 13: 191–193.
McCormack JG Nalidixic acid for shigellosis. Lancet 1983, ii: 1091.
Malengreau M Nalidixic acid inShigella dysenteriae outbreaks. Lancet 1984, ii: 172.
Haltalin KC, Nelson JD, Kusmiesz HT Comparative efficacy of nalidixic acid and ampicillin for severe shigellosis. Archives of Diseases of Children 1973, 48: 305–312.
Gotuzzo E, Oberhelman RA, Maguina C, Berry SJ, Yi A, Guzman M, Ruiz R, Leon-Barua R, Sack RB Comparison of single-dose treatment with norfloxacin and standard 5-day treatment with trimethoprim-sulfamethoxazole for acute shigellosis in adults. Antimicrobial Agents and Chemotherapy 1989, 33: 1101–1104.
Aserkov B, Bennett JV Effect of antibiotic therapy in acute salmonellosis on the fecal excretion of salmonellae. New England Journal of Medicine 1969, 281: 636–640.
Pichler HET, Diridl G, Stickler K, Wolf D Clinical efficacy of ciprofloxacin compared with placebo in bacterial diarrhea. American Journal of Medicine 1987, 82, Supplement 4A: 329–332.
Goodman LJ, Kaplan RL, Petrak RM, Fliegelman RM, Taff D, Walton F, Penner JL, Trenholme GM Effects of erythromycin and ciprofloxacin on chronic fecal excretion ofCampylobacter species on marmosets. Antimicrobial Agents and Chemotherapy 1986, 29: 185–187.
Bhattacharya D, Sen G, Nair GB, Bhattacharya MK, Datta P, Datta D Multiple drug-resistantShigella dysenteriae type 1 and travelers' diarrhea. Journal of Infectious Diseases 1986, 154: 729–730.
Johnson PC, Ericsson CD, Morgan DR, DuPont HL, Cabada FJ Lack of emergence of resistant fecal flora during successful prophylaxis of traveler's diarrhea with norfloxacin. Antimicrobial Agents and Chemotherapy 1986, 30: 671–674.
Wiström J, Norrby SR, Burman LG, Lindholm R, Jellheden B, Englund G Norfloxacin versus placebo for prophylaxis against travelers' diarrhoea. Journal of Antimicrobial Chemotherapy 1987, 20: 563–574.
Gough A, Barsoum NJ, Mitchell L, McGuire EJ, de la Iglesa, FA Juvenile canine drug-induced arthropathy: clinicopathological studies on articular lesions caused by oxolonic and pipemidic acids. Toxicology and Applied Pharmacology 1979, 51: 177–187.
Schlüter G: Toxicology of ciprofloxacin. In: Neu HC, Weuta H (ed): International Ciprofloxacin Workshop. Proceedings of the First Excerpta Medica, Amsterdam, 1986, p. 61–70.
Schaad UB, Wedgewood-Krucko J Nalidixic acid in children: retrospective matched controlled study for cartilage toxicity. Infection 1987, 15: 165–168.
Enzensberger R, Shah PM, Knothe H Impact of oral ciprofloxacin on the faecal flora of healthy volunteers. Infection 1985, 13: 273–275.
Holt HA, Lewis DA, White LO, Bastable SY, Reeves DS Effect of oral ciprofloxacin on the faccal flora of healthy volunteers. European Journal of Clinical Microbiology 1986, 5:201–205.
Bergan T, Delin C, Johansen S, Kolstad IM, Nord CE, Thorsteinsson SB Pharmacokinetics of ciprofloxacin and effect of repeated dosage on salivary and fecal microflora. Antimicrobial Agents and Chemotherapy 1986, 29: 298–302.
Pecquet S, Andremont A, Tancrede C Effect of oral ofloxacin on fecal bacteria in human volunteers. Antimicrobial Agents and Chemotherapy 1987, 31: 124–125.
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DuPont, H.L. Use of quinolones in the treatment of gastrointestinal infections. Eur. J. Clin. Microbiol. Infect. Dis. 10, 325–329 (1991). https://doi.org/10.1007/BF01967006
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DOI: https://doi.org/10.1007/BF01967006