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Bacteria Causing Gastrointestinal Infections
Published in K. Balamurugan, U. Prithika, Pocket Guide to Bacterial Infections, 2019
B. Vinoth, M. Krishna Raja, B. Agieshkumar
These organisms were first described from Calcutta in India by De et al. in the year 1956 and were later reported from other areas of the world. In developing countries, they are one of the leading cause of diarrhea in children younger than 5 years of age, with an estimated annual incidence of 280 million cases with 380,000 deaths (Wennerås and Erling 2004; Ochoa and Contreras 2011). They were the most common cause of community-acquired diarrhea (14.1%) and was associated with 9.5% of hospital-acquired diarrhea according to data between 1990 and 2000 (Lanata et al. 2002). It is also the leading cause of traveler’s diarrhea.
Levofloxacin
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Traveler’s diarrhea is a syndrome caused by various pathogens, including enteropathogenic E. coli, Salmonella spp., and Campylobacter spp., with the proportions of each pathogen depending on the area of travel. Levofloxacin given as a single daily oral dose of 500 mg for 3 days has been compared with azithromycin given as a single dose of 1 g or 500 mg daily for 3 days for treatment of patients with traveler’s diarrhea in Thailand, where Campylobacter spp. are the dominant pathogens (Tribble et al., 2007). At 72 hours after initiation of therapy, the levofloxacin regimen was the least effective, with resolution of diarrhea in 71% of patients in comparison to 85% of patients given 3 days of azithromycin and 96% of those given the single dose of azithromycin. Similar differences were seen in microbiologic eradication (levofloxacin 36% vs. azithromycin regimens 96–100%), and the poorer outcomes correlated with the occurrence of levofloxacin resistance, which was present in half of Campylobacter isolates. In contrast, in Turkey, where traveler’s diarrhea is most often due to enterotoxigenic E. coli (ETEC), a single dose of azithromycin (1 g) or levofloxacin (500 mg), each together with loperamide, produced comparable resolution of symptoms (Sanders et al., 2007). Eradication of ETEC from stool was also similar with the two regimens (85% and 81%), but Campylobacter spp. were eliminated from stool in 4 of 6 patients (67%) treated with azithromycin and in 0 of 9 patients treated with levofloxacin. Susceptibility data on the stool pathogens were not reported. Single doses of levofloxacin and azithromycin also had similar clinical efficacy in patients with traveler’s diarrhea in Mexico, where ETEC also predominated, and Campylobacter spp. were not detected (Adachi et al., 2003). Thus the suitability of levofloxacin or other fluoroquinolones for treatment of traveler’s diarrhea is currently inversely dependent on the likelihood of resistant Campylobacter infection at the site of travel.
Enterotoxigenic Escherichia coli: intestinal pathogenesis mechanisms and colonization resistance by gut microbiota
Published in Gut Microbes, 2022
Yucheng Zhang, Peng Tan, Ying Zhao, Xi Ma
In the cases of ETEC infection, the clinical manifestations are characterized by acute watery diarrhea leading to rapid dehydration and prostration within a few hours, which is similar to the clinical manifestations of cholera.8 ETEC infection is followed by a variety of symptoms, including vomiting, stomach cramps, headache, and, in rare cases, a slight fever.9 Some existing findings suggested that ETEC infection may be associated with some sequelae, such as raising the risk of childhood stunting due to immunological deficiencies and malnutrition, increasing the likelihood of contracting other infectious illnesses, and even influencing cognitive development.5,10,11 Furthermore, there is a link between traveler’s diarrhea and post-infectious irritable bowel syndrome.3 So far, antibiotics and oral rehydration are the most popular treatments, while antibiotics create a large number of resistant strains and eliminate beneficial bacteria in the gut, making it imperative to find alternative treatments.
The safety of antimicrobials for the treatment of community-acquired pneumonia
Published in Expert Opinion on Drug Safety, 2020
Carla Bastida, Dolors Soy, Antoni Torres
In December 2016, the Food and Drug Administration (FDA) issued a Drug Safety Communication advising that the use of fluoroquinolone antibiotics be restricted for uncomplicated infections when there are alternative treatment options [50]. This was based on safety review showing that the systemic use of fluoroquinolones was associated with disabling and potentially permanent serious side effects involving tendons, muscles, joints, nerves, and the CNS. More recently, in November 2018, the European Medicines Agency suspended their marketing authorization for medicines containing cinoxacin, flumequine, nalidixic acid, and pipemidic acid [51]. They also recommended restricting the use of all other fluoroquinolones. Specifically, they should not be used for the following: (i) infections that might improve without treatment or that are not severe (e.g. throat infections); (ii) non-bacterial infections (e.g. non-bacterial chronic prostatitis); (iii) traveler’s diarrhea or recurring lower urinary tract infections; or (iv) mild or moderate bacterial infections, unless other antibacterial medicines commonly recommended for these infections cannot be used. They also reminded prescribers that fluoroquinolones should be avoided in patients who have previously experienced these serious side effects, and that caution should be exercised in groups at higher risk of tendon injury (e.g. the elderly, corticosteroid users, patients with kidney disease, and organ transplant recipients).
Global travel and Gram-negative bacterial resistance; implications on clinical management
Published in Expert Review of Anti-infective Therapy, 2021
Nicolette Theriault, Glenn Tillotson, Christian E Sandrock
The development of a systematic approach to travel-related antimicrobial resistance is difficult. Antimicrobial surveillance methodologies, infrastructure, and resources are not standardized among all countries which would need to be considered in clinical practice but this can be difficult. However, ongoing monitoring of regions of high resistance is the first step. In regions of high resistance, broader coverage should be initiated. Secondly, the type of infection will impact the likelihood of resistance. For example, traveler’s diarrhea has the highest rate of drug resistance of any travel-related infection. In fact, recent changes in guidelines and clinical practice can be implemented to have positive real-world outcomes. The 2019 updates to ‘Travelers’ diarrhea (TD): Clinical practice guidelines for pharmacists’ recommend that generally prophylactic antibiotics should not be given, but allows for use in at risk patients with immune disorders, and also identifies travelers who due to their occupation or itinerary cannot afford to become sick with TD (i.e. athletes in competition, musicians, politicians, presenters at professional conference or meeting) [117]. Healthcare-associated infections (medical tourism) will have much higher rates of resistance when compared to community-acquired cases regardless of rates of resistance. Finally, pre-travel and intra-travel antimicrobial prescription use will affect organism selection and resistance. Determining antimicrobial use along with patient education becomes key. Improving patient education by changing the discourse between clinicians and patients about antibiotic treatment and traveler’s diarrhea could reduce this prescribing practice.