Katri Vilkman1, Tinja Lääveri2, Sari H Pakkanen3, Anu Kantele4. 1. Department of Bacteriology and Immunology, University of Helsinki, P.O. Box 21, FI-00014, Finland; Inflammation Center, Division of Infectious Diseases, University of Helsinki and Helsinki University Hospital, P.O. Box 348, FI-00029, Finland. Electronic address: katri.vilkman@helsinki.fi. 2. Inflammation Center, Division of Infectious Diseases, University of Helsinki and Helsinki University Hospital, P.O. Box 348, FI-00029, Finland. Electronic address: tinja.laaveri@hus.fi. 3. Department of Bacteriology and Immunology, University of Helsinki, P.O. Box 21, FI-00014, Finland. Electronic address: sari.pakkanen@helsinki.fi. 4. Inflammation Center, Division of Infectious Diseases, University of Helsinki and Helsinki University Hospital, P.O. Box 348, FI-00029, Finland; Unit of Infectious Diseases, Department of Medicine/Solna, Karolinska Institutet, SE-17176 Stockholm, Sweden; Travel Clinic, Aava Medical Center, Annankatu 32, FI-00100 Helsinki, Finland. Electronic address: anu.kantele@hus.fi.
Abstract
BACKGROUND: As antibiotics predispose travelers to acquiring multidrug-resistant intestinal bacteria, they should no longer be considered a mainstay for treating travelers' diarrhea. It has been claimed that stand-by antibiotics are justified as a means to avoid visits to local healthcare providers which often lead to polypharmacy. METHOD: We revisited the traveler data of 316 prospectively recruited volunteers with travelers' diarrhea by retrieving from questionnaires and health diaries information on antibiotic use, stand-by antibiotic carriage, and visits with local healthcare. Multivariable analysis was applied to identify factors associated with antibiotic use. RESULTS: Among our 316 volunteers with travelers' diarrhea, however, carrying stand-by antibiotics seemed not to reduce the rate of healthcare-seeking; on the contrary, antibiotic use was more frequent among stand-by antibiotic carriers (34%) than non-carriers (11%). Antibiotics were equally taken for severe and incapacitating travelers' diarrhea, but compared to non-carriers, stand-by antibiotic carriers resorted to medication also for mild/moderate (38% vs. 4%) and non-incapacitating disease (29% vs. 5%). Antibiotic use was associated with stand-by antibiotic carriage (OR 7.2; 95%CI 2.8-18.8), vomiting (OR 3.5; 95%CI 1.3-9.5), incapacitating diarrhea (OR 3.6; 95%CI 1.3-9.8), age (OR 1.03; 95%CI 1.00-1.05), and healthcare visit for diarrhea (OR 465.3; 95%CI 22.5-9633.6). CONCLUSIONS: Carriage of stand-by antibiotics encouraged less cautious use of antibiotics. Recommendations involving prescription of antibiotics for all travelers require urgent revision.
BACKGROUND: As antibiotics predispose travelers to acquiring multidrug-resistant intestinal bacteria, they should no longer be considered a mainstay for treating travelers' diarrhea. It has been claimed that stand-by antibiotics are justified as a means to avoid visits to local healthcare providers which often lead to polypharmacy. METHOD: We revisited the traveler data of 316 prospectively recruited volunteers with travelers' diarrhea by retrieving from questionnaires and health diaries information on antibiotic use, stand-by antibiotic carriage, and visits with local healthcare. Multivariable analysis was applied to identify factors associated with antibiotic use. RESULTS: Among our 316 volunteers with travelers' diarrhea, however, carrying stand-by antibiotics seemed not to reduce the rate of healthcare-seeking; on the contrary, antibiotic use was more frequent among stand-by antibiotic carriers (34%) than non-carriers (11%). Antibiotics were equally taken for severe and incapacitating travelers' diarrhea, but compared to non-carriers, stand-by antibiotic carriers resorted to medication also for mild/moderate (38% vs. 4%) and non-incapacitating disease (29% vs. 5%). Antibiotic use was associated with stand-by antibiotic carriage (OR 7.2; 95%CI 2.8-18.8), vomiting (OR 3.5; 95%CI 1.3-9.5), incapacitating diarrhea (OR 3.6; 95%CI 1.3-9.8), age (OR 1.03; 95%CI 1.00-1.05), and healthcare visit for diarrhea (OR 465.3; 95%CI 22.5-9633.6). CONCLUSIONS: Carriage of stand-by antibiotics encouraged less cautious use of antibiotics. Recommendations involving prescription of antibiotics for all travelers require urgent revision.
Authors: Daloha Rodríguez-Molina; Fanny Berglund; Hetty Blaak; Carl-Fredrik Flach; Merel Kemper; Luminita Marutescu; Gratiela Pircalabioru Gradisteanu; Marcela Popa; Beate Spießberger; Laura Wengenroth; Mariana Carmen Chifiriuc; D G Joakim Larsson; Dennis Nowak; Katja Radon; Ana Maria de Roda Husman; Andreas Wieser; Heike Schmitt Journal: Int J Environ Res Public Health Date: 2022-04-14 Impact factor: 4.614
Authors: H J Prudden; M Hasso-Agopsowicz; R E Black; C Troeger; R C Reiner; R F Breiman; M Jit; G Kang; L Lamberti; C F Lanata; B A Lopman; W Ndifon; V E Pitzer; J A Platts-Mills; M S Riddle; P G Smith; R Hutubessy; B Giersing Journal: Vaccine Date: 2020-04-03 Impact factor: 3.641
Authors: Julian E Grass; Sunkyung Kim; Jennifer Y Huang; Stephanie M Morrison; Andre E McCullough; Christy Bennett; Cindy R Friedman; Anna Bowen Journal: PLoS One Date: 2019-12-04 Impact factor: 3.240
Authors: David R Stagliano; Claire Kuo; Jamie A Fraser; Indrani Mitra; Eric C Garges; Mark S Riddle; David R Tribble; Patrick W Hickey Journal: Am J Trop Med Hyg Date: 2022-02-21 Impact factor: 2.345