Diarrhoea ciprofloxacin

More severe cases may benefit from antibiotic therapy, which may also shorten the duration of the illness. Antibiotic treatment may itself result in diarrhoea. Ciprofloxacin is the antibiotic of choice. The adult regimen is 500 mg orally every 12 hours for between 7 and 10 days. The use of ciprofloxacin is not advised in children due to the risk of arthropathies, although where the benefit outweighs this risk the dosage is 5-15 mg/kg orally every 12 hours. More severe infections may be treated initially by intravenous antibiotic therapy. 

Antibiotic therapy is justified where there is suspicion of giardiasis (metronidazole) and bismuth subsalicylate is effective in acute travellers diarrhoea, as are agents such as ciprofloxacin. In tropical areas where there is suspicion of amoebic disease metronidazole should be given early. 

Escherichia coli is a normal inhabitant of the bowel but some enterotoxigenic strains are pathogenic and are frequently a cause of travellers diarrhoea. A quinolone, e.g. ciprofloxacin, is the drug of choice in most high-risk parts of the world for a severe attack (see Travellers diarrhoea, p. 644). Antimicrobials are not generally given for prophylaxis but, when it is indicated, a quinolone should be used. 

Vibrio cholerae. The cause of death in cholera is electrolyte and fluid loss in the stools and this may exceed 11/h. The most important aim of treatment is prompt replacement and maintenance of water and electrolytes with oral or intravenous electrolyte solutions. Doxycycline, given early, significantly reduces the amount and duration of diarrhoea and eliminates the organism from the faeces (thus lessening the contamination of the environment). Carriers may be treated by doxycycline by mouth in high dose for 3 days. Ciprofloxacin may be given for resistant organisms. 

Acute watery diarrhoea in adults can usually be controlled by oral rehydration solutions and one of the antimotility drugs, although in mild cases the abdominal bloating produced by the latter may be less acceptable than the loose stools. While diarrhoea usually lasts only 2-3 days, this may stiU be socially inconvenient, and if s5rmptomatic remedies fail, an aminoquinolone, e.g. ciprofloxacin 500 mg b.d. will be effective. The use of antimicrobials for travellers diarrhoea continues to evoke controversy (see below) but most sufferers will appreciate the relief that even one or two tablets can bring. 

Prophylactic antimicrobial therapy has been shown to reduce the incidence of attacks of diarrhoea but its routine use carries the risk of hindering the diagnosis of serious infection. A wider issue is the possible development and spread of antibiotic-resistant organisms. Thus any benefits to the individual must be weighed against the risk to the community in the future. In most instances prophylactic antimicrobials should not be used but ciprofloxacin (500 mg once daily) may be justified for individuals who must remain well while travelling for short periods to high-risk areas. 

Activated charcoal is also included in various remedies used for gastrointestinal disorders such as flatulence or diarrhoea. Doses in these instances are very much lower (1 to 2 g daily) than those used in the treatment of poisoning, and there seems to be little reported about the effects of these doses on the absorption of other drugs. In one single-dose study in healthy subjects, nizatidine absorption was reduced by about 30% when it was taken one hour before activated charcoal 2 g. In another single-dose study in 6 subjects, taking activated charcoal 1 g soon after ciprofloxacin 500 mg, had little effect on the pharmacokinetics of ciprofloxacin 500 mg (AUC reduced by 10%). ... 

A randomised, placebo-controlled trial using 500 mg ciprofloxacin twice daily for the prevention of postoperative recurrence of Crohn s disease did not show a benefit of the treatment over the disease. The following adverse events were listed diarrhoea, headache, sxm sensitivity, yeast infection, oral candidiasis, difficulty breathing, pharyngeal paraesthesia and tendonitis. Twenty-four percent of subjects (four cases) withdrew due to adverse events [23 ]. These are all expected side effects of ciprofloxacin. Similarly, use of ciprofloxacin 300 mg twice daily in febrile... 

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