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Current problems in antimicrobial therapy for bacterial enteric infection
Abstract:
Trimethoprim/sulfamethoxazole is currently considered the treatment of choice for shigellosis and severe travelers' diarrhea. The problem with this combination regimen is inactivity against Campylobacter jejuni strains and other bacterial enteropathogens showing in vitro resistance to the drug. Resistance to trimethoprim/sulfamethoxazole among enteric pathogens has occurred frequently in certain areas of the world. A study of the in vitro susceptibility of enteric bacterial pathogens isolated from multiple countries was recently performed. The minimal inhibitory concentration of ciprofloxacin required to inhibit 90 percent of the 210 bacterial enteropathogens ranged from 0.25 micrograms/ml for C. jejuni to 0.016 micrograms/ml for enterotoxigenic Escherichia coli, Salmonella, and Shigella. In a clinical trial carried out in a United States student population that acquired diarrhea while in Mexico, it was shown that ciprofloxacin was as effective as trimethoprim/sulfamethoxazole and both were significantly (p less than 0.001) more effective than placebo. The average duration of diarrhea was 29 or 20 hours after initiation of treatment with ciprofloxacin or trimethoprim/sulfamethoxazole, respectively, compared with 81 hours in the placebo group. The antimicrobial agents were more efficacious than placebo in treating diarrhea caused by enterotoxigenic E. coli, invasive enteropathogens, and unknown pathogens. Ciprofloxacin and the quinolone derivatives are uniquely suited to the therapy of acute bacterial diarrhea in areas where C. jejuni is commonly found and where trimethoprim/sulfamethoxazole-resistant strains regularly occur.
Insights
Ciprofloxacin is effective for bacterial diarrhea, including against resistant strains. It offers a valuable alternative to trimethoprim/sulfamethoxazole, especially where resistance is common.
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Background:
- Trimethoprim/sulfamethoxazole is a primary treatment for shigellosis and travelers' diarrhea.
- Increasing resistance to trimethoprim/sulfamethoxazole in enteric pathogens limits its efficacy.
- Campylobacter jejuni and other enteropathogens exhibit resistance to this combination therapy.
Purpose of the Study:
- To evaluate the in vitro susceptibility of enteric bacterial pathogens to ciprofloxacin.
- To compare the clinical efficacy of ciprofloxacin versus trimethoprim/sulfamethoxazole in treating bacterial diarrhea.
- To assess the effectiveness of these antibiotics against various enteropathogens.
Main Methods:
- In vitro susceptibility testing of 210 bacterial enteropathogens to determine minimal inhibitory concentrations (MICs).
- A clinical trial involving a student population with diarrhea acquired in Mexico.
- Comparison of treatment outcomes (duration of diarrhea) between ciprofloxacin, trimethoprim/sulfamethoxazole, and placebo groups.
Main Results:
- Ciprofloxacin demonstrated low MICs against a range of enteropathogens, including C. jejuni, E. coli, Salmonella, and Shigella.
- Both ciprofloxacin and trimethoprim/sulfamethoxazole were significantly more effective than placebo in reducing diarrhea duration (29 and 20 hours vs. 81 hours, respectively).
- Antimicrobial treatment was efficacious against enterotoxigenic E. coli, invasive enteropathogens, and unknown pathogens.
Conclusions:
- Ciprofloxacin is a viable and effective treatment for acute bacterial diarrhea, particularly in regions with high rates of trimethoprim/sulfamethoxazole resistance.
- Quinolone derivatives like ciprofloxacin are well-suited for treating bacterial diarrhea where C. jejuni is prevalent and resistance is a concern.
- Ciprofloxacin provides an effective therapeutic option, addressing limitations of traditional treatments.