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Charles D. Ericsson, MD; Herbert L. DuPont, MD; John J. Mathewson, PhD; M. Stewart West, PhD; Philip C. Johnson, MD; Jo Ann M. Bitsura, MPH

JAMA. 1990;263(2):257-261.

Abstract
In a randomized, double-blind, placebo-controlled trial, 227 US adults with acute diarrhea in Mexico received a single dose of sulfamethoxazole and trimethoprim (1600/320 mg) or 3 days of therapy with loperamide hydrochloride (4-mg loading dose, then 2 mg orally after each loose stool), sulfamethoxazole-trimethoprim (800/160 mg orally twice daily), or the combination of both. Subjects treated with the combination had the shortest average duration of diarrhea compared with the placebo group (1 hour vs 59 hours), took the least amount of loperamide after the loading dose (3.8 mg), and had the shortest duration of diarrhea associated with fecal leukocytes or blood-tinged stools (4.5 hours). A single dose of sulfamethoxazole-trimethoprim was also efficacious (28 vs 59 hours), but loperamide alone was significantly effective only when treatment failures were treated with antibiotics (33 vs 58 hours). The combination of sulfamethoxazole-trimethoprim plus loperamide can be highly recommended for the treatment of most patients with travelers diarrhea.

(JAMA. 1990;263:257-261)

Author Affiliations
From the Division of Infectious Diseases, Department of Medicine, University of Texas Medical School at Houston. Dr West is now with the Department of Medicine, Baylor College of Medicine, Houston.

Footnotes
Presented at the Annual Meeting of the American Federation of Clinical Research, Washington, DC, April 28,1988.

Reprint requests to Division of Infectious Diseases, Department of Medicine, University of Texas Medical School at Houston, 6431 Fannin St, Room 1.728, Houston, TX 77030 (Dr Ericsson).

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