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Loperamide safe alternative for traveler’s diarrhea
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Loperamide is a safe alternative to antimicrobial drugs for traveler’s diarrhea as it does not increase the risk for colonization with extended-spectrum beta-lactamase–producing Enterobacteriaceae, according to a study published in Emerging Infectious Diseases.
“Some researchers have posed the question as to whether the antimotility effect of loperamide, involving prolonged passage through the gastrointestinal tract, would, in fact, increase the risk for colonization,” Anu Kantele, MD, PhD, an associate professor and senior lecturer at the University of Helsinki, Finland, and colleagues wrote. “Such speculations prompted us to revisit our recent data to compare loperamide, [antimicrobial drugs], and their combination in the treatment of [traveler’s diarrhea] with regard to the risk for contracting travel-acquired [extended-spectrum beta-lactamase (ESBL)–producing Enterobacteriaceae].”
Anu Kantele
To compare the treatments, the researchers reviewed the ESBL-producing Enterobacteriaceae acquisition data they had recently obtained from 430 travelers from Finland, choosing to focus on those with traveler’s diarrhea in a separate analysis. The volunteers provided fecal samples and completed questionnaires before and after travel. The post-travel surveys included questions regarding symptoms of traveler’s diarrhea and the use of loperamide and antimicrobial drugs. In all, 288 of the travelers who reported diarrhea were included in the final study group.
The participants were separated into four groups based on how they treated their traveler’s diarrhea — those who took no medications, those who took only loperamide, those who took only antimicrobials and those who took a combination of both.
According to the researchers, 26% of the travelers contracted ESBL-producing Enterobacteriaceae, including 21% of travelers who did not take medication, 20% who took loperamide only, 40% who took antimicrobials only, and 71% who had used both treatments. In addition, the researchers found that the traveler’s destination was an independent risk factor for colonization with ESBL-producing Enterobacteriaceae, and that sharing meals with locals appeared to be protective against the bacteria.
“Our results show that loperamide alone offers a safe alternative to [antimicrobial drugs] for traveler’s diarrhea treatment, because it does not add to the risk for acquiring drug-resistant intestinal bacteria,” Kantele and colleagues wrote. “In contrast, combining loperamide with [antimicrobial drugs] predisposes to [ESBL-producing Enterobacteriaceae] colonization and may add to the substantial risk posed by [antimicrobial drugs] alone. Our data dispute the safety of this combination.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.
Editor's Note: The data were updated on Jan. 25 to more accurately reflect the percentage of travelers who contracted ESBL-producing Enterobacteriaceae. The editor's regret the error.
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