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. 1986 Nov;30(5):671–674. doi: 10.1128/aac.30.5.671

Lack of emergence of resistant fecal flora during successful prophylaxis of traveler's diarrhea with norfloxacin.

P C Johnson, C D Ericsson, D R Morgan, H L Dupont, F J Cabada
PMCID: PMC176511  PMID: 3800342

Abstract

Norfloxacin, a new quinolone carboxylic acid derivative, was compared with an identical-appearing placebo preparation in a prospective, randomized, double-blind trial for prevention of traveler's diarrhea among 120 U.S. students arriving in Mexico. Prophylaxis was continued for 2 weeks. Diarrhea was defined as four unformed stools in 24 h plus an additional symptom of enteric disease. In the norfloxacin prophylaxis group, 4 of 56 subjects (7%) experienced diarrhea, compared with 36 of 59 subjects (61%) in the placebo group. The difference was significant (P less than 0.0001). In contrast to our previous experience with use of trimethoprim-sulfamethoxazole to prevent traveler's diarrhea, quantitative stool cultures in the norfloxacin-treated group revealed a significant decline of normal aerobic fecal flora during prophylaxis (P less than 0.0005). Among stool samples from norfloxacin-treated subjects, 32 of 38 (84%) cultured on day 7 and 34 of 37 (92%) cultured on day 14 had no gram-negative bacilli. After norfloxacin was discontinued, fecal flora returned to pretreatment levels. No gram-negative aerobic flora resistant to norfloxacin were found during weekly quantitative cultures before, during, or after therapy.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Burman L. G. Apparent absence of transferable resistance to nalidixic acid in pathogenic Gram-negative bacteria. J Antimicrob Chemother. 1977 Sep;3(5):509–516. doi: 10.1093/jac/3.5.509. [DOI] [PubMed] [Google Scholar]
  2. Carlson J. R., Thornton S. A., DuPont H. L., West A. H., Mathewson J. J. Comparative in vitro activities of ten antimicrobial agents against bacterial enteropathogens. Antimicrob Agents Chemother. 1983 Oct;24(4):509–513. doi: 10.1128/aac.24.4.509. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Cofsky R. D., duBouchet L., Landesman S. H. Recovery of norfloxacin in feces after administration of a single oral dose to human volunteers. Antimicrob Agents Chemother. 1984 Jul;26(1):110–111. doi: 10.1128/aac.26.1.110. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. DuPont H. L., Galindo E., Evans D. G., Cabada F. J., Sullivan P., Evans D. J., Jr Prevention of travelers' diarrhea with trimethoprim-sulfamethoxazole and trimethoprim alone. Gastroenterology. 1983 Jan;84(1):75–80. [PubMed] [Google Scholar]
  5. Ericsson C. D., DuPont H. L., Galindo E., Mathewson J. J., Morgan D. R., Wood L. V., Mendiola J. Efficacy of bicozamycin in preventing traveler's diarrhea. Gastroenterology. 1985 Feb;88(2):473–477. doi: 10.1016/0016-5085(85)90509-8. [DOI] [PubMed] [Google Scholar]
  6. Mathewson J. J., Johnson P. C., DuPont H. L., Morgan D. R., Thornton S. A., Wood L. V., Ericsson C. D. A newly recognized cause of travelers' diarrhea: enteroadherent Escherichia coli. J Infect Dis. 1985 Mar;151(3):471–475. doi: 10.1093/infdis/151.3.471. [DOI] [PubMed] [Google Scholar]
  7. Merson M. H., Morris G. K., Sack D. A., Wells J. G., Feeley J. C., Sack R. B., Creech W. B., Kapikian A. Z., Gangarosa E. J. Travelers' diarrhea in Mexico. A prospective study of physicians and family members attending a congress. N Engl J Med. 1976 Jun 10;294(24):1299–1305. doi: 10.1056/NEJM197606102942401. [DOI] [PubMed] [Google Scholar]
  8. Murray B. E., Rensimer E. R., DuPont H. L. Emergence of high-level trimethoprim resistance in fecal Escherichia coli during oral administration of trimethoprim or trimethoprim--sulfamethoxazole. N Engl J Med. 1982 Jan 21;306(3):130–135. doi: 10.1056/NEJM198201213060302. [DOI] [PubMed] [Google Scholar]
  9. Rowe B., Threlfall E. J. Drug resistance in gram-negative aerobic bacilli. Br Med Bull. 1984 Jan;40(1):68–76. doi: 10.1093/oxfordjournals.bmb.a071950. [DOI] [PubMed] [Google Scholar]
  10. Sack D. A., Kaminsky D. C., Sack R. B., Itotia J. N., Arthur R. R., Kapikian A. Z., Orskov F., Orskov I. Prophylactic doxycycline for travelers' diarrhea. Results of a prospective double-blind study of Peace Corps volunteers in Kenya. N Engl J Med. 1978 Apr 6;298(14):758–763. doi: 10.1056/NEJM197804062981402. [DOI] [PubMed] [Google Scholar]
  11. Sack R. B., Froehlich J. L., Zulich A. W., Hidi D. S., Kapikian A. Z., Orskov F., Orskov I., Greenberg H. B. Prophylactic doxycycline for travelers' diarrhea: results of a prospective double-blind study of Peace Corps volunteers in Morocco. Gastroenterology. 1979 Jun;76(6):1368–1373. [PubMed] [Google Scholar]
  12. Sack R. B., Santosham M., Froehlich J. L., Medina C., Orskov F., Orskov I. Doxycycline prophylaxis of travelers' diarrhea in Honduras, an area where resistance to doxycycline is common among enterotoxigenic Escherichia coli. Am J Trop Med Hyg. 1984 May;33(3):460–466. doi: 10.4269/ajtmh.1984.33.460. [DOI] [PubMed] [Google Scholar]
  13. Santosham M., Sack R. B., Froehlich J., Greenberg H., Yolken R., Kapikain A., Javier C., Medina C., Orskov F., Orskov I. Biweekly prophylactic doxycycline for travelers' diarrhea. J Infect Dis. 1981 Apr;143(4):598–602. doi: 10.1093/infdis/143.4.598. [DOI] [PubMed] [Google Scholar]
  14. Shungu D. L., Weinberg E., Gadebusch H. H. In vitro antibacterial activity of norfloxacin (MK-0366, AM-715) and other agents against gastrointestinal tract pathogens. Antimicrob Agents Chemother. 1983 Jan;23(1):86–90. doi: 10.1128/aac.23.1.86. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Tiemens K. M., Shipley P. L., Correia R. A., Shields D. S., Guerrant R. L. Sulfamethoxazole-trimethoprim-resistant Shigella flexneri in northeastern Brazil. Antimicrob Agents Chemother. 1984 May;25(5):653–654. doi: 10.1128/aac.25.5.653. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Wood L. V., Morgan D. R., DuPont H. L. Antimicrobial resistance of gram-negative bacteria isolated from foods in Mexico. J Infect Dis. 1983 Oct;148(4):766–766. doi: 10.1093/infdis/148.4.766. [DOI] [PubMed] [Google Scholar]

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