Hl. Dupont et al., ORAL AZTREONAM, A POORLY ABSORBED YET EFFECTIVE THERAPY FOR BACTERIALDIARRHEA IN UNITED-STATES TRAVELERS TO MEXICO, JAMA, the journal of the American Medical Association, 267(14), 1992, pp. 1932-1935
Objective. - To evaluate a poorly absorbed antimicrobial with in vitro
activity against all major bacterial enteropathogens in oral therapy
for bacterial diarrhea. Design. - One hundred ninety-one US students w
ith diarrhea acquired in Mexico received 100 mg of aztreonam or matchi
ng placebo three times a day for 5 days. Stools were cultured for bact
erial enteropathogens before and after therapy. Setting. - We studied
US students who acquired diarrhea in Mexico (travelers' diarrhea) in v
iew of the high frequency of bacterial agents in this setting. Main Ou
tcome Measure. - We examined time of clinical recovery, treatment fail
ures, adverse experiences, and microbiologic eradication from stool of
the etiologic agent in subjects randomized to receive aztreonam or pl
acebo. Results. - Aztreonam reduced the average duration of diarrhea c
ompared with the placebo: for all cases, by 40 hours (P << .01); for t
hose with enterotoxigenic Escherichia coli diarrhea, by 50 hours (P <
.01); for those with shigellosis, by 90 hours (P, not significant [sma
ll sample size]); for all bacterial agents, by 57 hours (P << .01). Cl
inical failures during the 5 days of therapy were seen in six patients
(6%) receiving aztreonam and 25 (27%) receiving placebo (P < .01). Pa
thogen eradication occurred in 95% of those receiving aztreonam and in
70% of those receiving the placebo (P < .01). All bacterial enteropat
hogens were susceptible in vitro to aztreonam. The drug was well toler
ated. Conclusions. - Oral aztreonam, which is poorly absorbed, was wel
l tolerated and was an effective therapy for bacterial diarrhea in US
adults in Mexico.