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Cited by 242Salmonella and Campylobacter epidemiologyTravel-related health issuesViral gastroenteritis research and epidemiology

Use of Azithromycin for the Treatment of Campylobacter Enteritis in Travelers to Thailand, an Area Where Ciprofloxacin Resistance Is Prevalent

Kuschner, R. A., Trofa, A. F., Thomas, R. J., Hoge, C. W., Pitarangsi, C., Amato, S., Olafson, R. P., Echeverria, P. +2 more·1995·Clinical Infectious Diseases
DOI 10.1093/clinids/21.3.536
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Abstract

We evaluated the use of azithromycin (500 mg) or ciprofloxacin (500 mg) daily for 3 days for the treatment of acute diarrhea among United States military personnel in Thailand. Stool cultures were obtained and symptoms were recorded on study days 0, 1, 2, 3, and 10. Campylobacter species were the most common pathogen isolated (44 isolates from 42 patients). All Campylobacter isolates were susceptible to azithromycin; 22 were resistant to ciprofloxacin. Among the 42 patients with campylobacter infection, there were 2 clinical and 6 bacteriologic treatment failures in the ciprofloxacin group and no treatment failures in the azithromycin group (P = .021 for bacteriologic failures). Overall, azithromycin was as effective as ciprofloxacin in decreasing the duration of illness (36.9 hours vs. 38.2 hours, respectively) and the number of stools (6.4 vs. 7.8, respectively). Among those not infected with Campylobacter species (n = 30), the duration of illness was 32.9 hours vs. 20.7 hours (P = .03) for the azithromycin and ciprofloxacin groups, respectively. Azithromycin is superior to ciprofloxacin in decreasing the excretion of Campylobacter species and as effective as ciprofloxacin in shortening the duration of illness. Azithromycin therapy may be an effective alternative to ciprofloxacin therapy in areas where ciprofloxacin-resistant Campylobacter species are prevalent.

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  • Yersinia has symptoms similar to those of acute appendicitis, necessitating differential diagnosis.

    “Yersinia has symptoms similar to those of acute appendicitis, thus necessitating differential diagnosis [78].”

    From Guideline for the Antibiotic Use in Acute Gastroenteritis (2019) · cites this paper as [78]

  • For food-related outbreaks, the possible pathogen can be estimated based on the incubation period: 1-6 hours suggests S. aureus or Bacillus cereus producing emetic toxin; 8-16 hours suggests C. perfringens or B. cereus producing diarrheal toxin; and 16-72 hours suggests ETEC, Salmonella, Shigella, and Vibrio cholerae.

    “Short incubation periods of 1 - 6 hours are estimated to have been caused by consumption of toxins, so S. aureus or Bacillus cereus producing emetic toxin is suspected. C. perfringens or B. cereus producing diarrheal toxin are suspected for incubation periods of 8 - 16 hours, and Enterotoxigenic E. coli (ETEC), Salmonella, Shigella, and Vibrio cholerae may be suspected for incubation periods of 16”

    From Guideline for the Antibiotic Use in Acute Gastroenteritis (2019) · cites this paper as [78]

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Authors
Kuschner, R. A., Trofa, A. F., Thomas, R. J., Hoge, C. W., Pitarangsi, C., Amato, S., Olafson, R. P., Echeverria, P., Sadoff, J. C., & Taylor, D. N.
Affiliations
Armed Forces Research Institute of Medical Science (TH)
Corresponding author
Kuschner, R. A.
ORCID
Sadoff, J. C.
Venue
Clinical Infectious Diseases
Publisher
Oxford University Press (OUP)
Published
1995-09-01
Volume
21
Issue
3
Pages
536-541
ISSN
  • 1058-4838 (ISSN-L)
  • 1537-6591
DOI
10.1093/clinids/21.3.536
OpenAlex
W1964400832
Cited by
242
References
36
Citations by year
2026: 1 · 2025: 2 · 2024: 3 · 2023: 1 · 2022: 2 · 2021: 5 · 2020: 2 · 2019: 5 · 2018: 5 · 2017: 8 · 2016: 6 · 2015: 6 · 2014: 8 · 2013: 4 · 2012: 5
FWCI
14.94
Type
journal article
Language
en
Open access
closed
Locations
  • Clinical Infectious Diseases (publishedVersion)
  • PubMed (publishedVersion)
Funders
U.S. Department of Defense
Topics
  • Life Sciences › Agricultural and Biological Sciences › Food Science › Salmonella and Campylobacter epidemiology
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Travel-related health issues
  • Health Sciences › Medicine › Infectious Diseases › Viral gastroenteritis research and epidemiology
Keywords
campylobacteriosis, azithromycin, ciprofloxacin, ciprofloxacin resistance, acute diarrhea, traveler's diarrhea, military personnel, Thailand, antibiotic treatment failure, disease duration
MeSH terms
Adult, Anti-Infective Agents, Anti-Bacterial Agents, Campylobacter, Campylobacter Infections, Ciprofloxacin, Diarrhea, Double-Blind Method, Drug Resistance, Microbial, Enteritis, Female, Humans, Male, Military Personnel, Thailand, Travel, United States, Azithromycin

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