Travelers' Diarrhea Diagnosis and Therapy Study in United States Military Personnel on Short-Term Deployment in Thailand
Abstract
Campylobacter species are the predominant cause of diarrhea in military travelers to Thailand, accounting for approximately 40-50% of evaluated cases. The clinical presentation and subsequent time to resolution for Campylobacter-associated cases differs from other etiologies in this setting, as evidenced by frequent systemic toxicity, increased diarrhea severity at presentation, delayed recovery, and higher 72-hour clinical failure rates ASSOCIATED WITH USE OF FLUOROQUINOLONE (FQ) antibiotics. These findings were observed during a period of time when the rates of FQ-resistant C. jejuni exceed 85% and the most common therapy prescribed was a FQ antibiotic. Diagnostic tests were evaluated in U.S. soldiers presenting with acute diarrhea during deployment in Thailand. Bedside and field laboratory diagnostic tests were compared to stool microbiology findings in 182 enrolled patients. Clinical findings, inflammatory screening tests STOOL HEMOCCULT, FECAL LEUKOCYTES, FECAL LACTOFERRIN (LFLA), plasma C-reactive protein, or Campylobacter-specific peripheral blood antibody-secreting cells failed to increase post-test probability above 90% in this Campylobacter hyperendemic setting. A Campylobacter-specific commercial EIA, and less so a research PCR, were strong positive predictors. Negative predictive value (reducing post-test probability less than 10%) was similarly observed with these Campylobacter-specific stool-based tests as well the fecal LFLA. A randomized, active drug-controlled, double-blinded study definitively demonstrated azithromycin to be the preferred antibiotic for traveler's diarrhea empiric treatment in Thailand. Clinical cure by 72 hours was highest at 96% with single dose azithromycin compared to 85% with 3-day azithromycin and 71% with levofloxacin (P=.002). Microbiologic eradication was significantly better for azithromycin-based regimens, 96-100%, as compared to levofloxacin at 38% (P=.001).
Document Details
- Document Type
- Technical Report
- Publication Date
- Jan 01, 2004
- Accession Number
- ADA435476
Entities
People
- David R
Organizations
- Uniformed Services University of the Health Sciences