Treatment of travellers diarrhea with trimethoprim/sulfamethoxazole and with trimethoprim alone: Dupont HL, Reeves RR, Galingo E, et al N Engl J Med 307:841–844 Sep 1982

✍ Scribed by Arthur B. Sanders

• Book ID: 104312484
• Publisher: Elsevier Science
• Year: 1983
• Tongue: English
• Weight: 112 KB
• Volume: 12
• Category: Article
• ISSN: 1097-6760
• DOI: 10.1016/s0196-0644(83)80401-6

✦ Synopsis

ICP was 15 m m Hg or less, the patients were continued on the standard protocol. If ICP reached 16 m m Hg or greater, 12.5 to 25 g mannitol every four to six hours was employed.

If ICP persisted at 16 m m Hg or greater, CSF was drained. The authors found the following. The overall mortality rates for various ICP subgroups were significantly different: 84% (36 of 43 patients) in Series I with ICP of 25 m m Hg or greater and 69% (18 of 26 patients) in Series II (P < .05). The mortality rates for patients with ICPs of less than 25 m m Hg were 26% and 15% for Series I and II, respectively (P < .025). The authors think this study reconfirms the high mortality rate when ICP is 25 m m Hg or greater. However, the data also document that early, aggressive treatment based on ICP monitoring significantly lessens the incidence of ICP of 25 m m Hg or greater and reduces the overall mortality rate of severe head injury.

M. Andrew Levitt, DO the cause was E coli, shigella, or as-yet-undetermined causes. They recommend treating symptomatic travellers diarrhea with antibiotics. [Editor's note: This is an excellent study demonstrating the effectiveness of treatment of diarrhea caused by E coli, shigella, and other pathogens. It also implies that other bacteria susceptible to antibiotic treatment may be causing a significant portion of infectious diarrheas.]