Antimicrobials

Antimicrobials are recommended to kill the bacterial pathogens (by far the most common cause of travelers' diarrhea) and, thus, cure the illness. The recommended drug at present for most parts of the world is ciprofloxacin (Cipro), 500 mg (or comparable doses of other fluro-quinolones) given twice daily for a relatively short period of time. Initial studies were done using 5 days of therapy, which was then reduced to 3 days. Now the recommended length of treatment is basically 1 day. The drug is first taken when the traveler realizes that he/she is becoming ill, and the second dose is taken 12 hours later. The illness is usually then curtailed within less than 24 hours.

The one area of the world that deserves special mention is Thailand and surrounding areas. Here the most frequent organism causing travelers' diarrhea is Campylobacter;over the past few years antimicrobial resistance has become frequent and Cipro no longer can be relied on to be effective. In these areas, azithromycin (Zithromax) 500 mg per day for 1 to 2 days has been shown to be effective. In the special case of treating small children, because cirpofloxacin may be contraindicated, azithromycin can be used in all areas of the world.

A new nonabsorbable antimicrobial preparation that may be used for treatment is Rifaxamin. It has recently been licensed in the United States as Xifaxan (Salix Pharmaceuticals, Raleigh, North Carolina). The advantages of this drug are that it reaches high concentrations in the bowel and it is not absorbed from the gut. The concentrations achieved are 200 times more than the minimal inhibitory concentrations (MIC's) of any of the known bacterial diarrheal pathogens. The drug has gone through several controlled trials and seems to be equivalent to ciprofloxacin or azithromycin in treatment of travelers' diarrhea (Dupont et al, 2001). It is given 2 to 3 times per day (200 or 400 mg) for 3 days. There is the possibility that this drug could also be used for prophylaxis, although this has not yet been studied.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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