Antibiotic treatment for travellers' diarrhoea

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Abstract
Using a pilot system we have categorised this review as: Current question ‐ update pending (See "Published notes" section for an explanation). Traveller's diarrhoea is a syndrome frequently encountered in persons crossing an international boundary. Diarrhoea can lead to significant discomfort and interference with travel plans. Bacterial pathogens are a frequent cause of this syndrome. Several antibiotics have been tested for efficacy in reducing the duration and severity of the illness. The aims of this review were to assess the effects of antibiotics on traveller's diarrhoea in relation to duration of illness, severity of illness, and adverse effects of medications. The Cochrane Collaboration Trials Register, MEDLINE, and EMBASE were searched. Additional trials were identified by hand searching. Content experts were contacted. All trials in any language in which travellers older than 5 years were randomly allocated to treatment for acute non‐bloody diarrhoea with antibiotics and where the causative organism is not known at allocation. Two reviewers assessed trial quality and extracted data. Twenty published studies met inclusion and quality criteria for inclusion. Twelve studies were placebo‐controlled. A meta‐analysis for the primary outcome was not feasible. All of the 10 trials reported a significant reduction in duration of diarrhoea in participants treated with antibiotics compared with placebo. Data from two trials demonstrated a small reduction for antibiotic treated patients in the number of unformed stools passed per each 24 hour period from randomisation up to 72 hours. Data from six trials demonstrated a greater number of participants being cured of diarrhoea by 72 hours (odds ratio 5.90, 95% confidence interval 4.06 to 8.57). Data regarding side effects were available from five trials. There was wide variation in the prevalence of side effects reported in different trials. Persons taking antibiotics experienced more side effects than those taking placebo (odds ratio 2.37, 95% confidence interval 1.50 to 3.75). Antibiotic treatment is associated with shorter duration of diarrhoea but higher incidence of side‐effects. Trials generally do not report duration of post‐treatment diarrhoea using time‐to‐event analyses, and should do. 針對旅遊者腹瀉的抗生素治療 旅遊者腹瀉是一個症候群，常發生於人們跨國旅遊時。腹瀉可以導致明顯的不舒服及擾亂旅遊計畫。對於這一個症候群，細菌是常見的致病原因。幾種抗生素已經被用來檢測降低這種疾病的時間及嚴重度的功效。 這一篇回顧的目標是針對使用抗生素治療旅遊者腹瀉與疾病持續時間、疾病嚴重度、及藥物副作用的關係。 蒐尋Cochrane Collaboration Trials Register、 MEDLINE、 及 EMBASE。我們也聯絡本主題專家與藉著傳統翻閱尋找更多的試驗。 任何語言發表,對象為大於5歲的非出血性腹瀉旅遊者,在致病原不清時被隨機分配抗生素治療的所有試驗。 兩位專家評估試驗的品質及擷取數據。 二十篇已經發表的研究符合納入及品質的標準。其中十二個研究有安慰劑控制組。一個針對首要結果的統合分析是不可行的。全部10個試驗報告使用抗生素治療與安慰劑的比較會使腹瀉的持續時間明顯降低。有兩個試驗的數據顯示在隨機分配後72小時內每24小時區間使用抗生素會使未成形的大便稍減。有六個試驗顯示許多的參與者經治療72小時後其腹瀉被治癒(odds ratio 5.90, 95%confidence interval 4.06 to 8.57)。關於副作用的數據可在五個試驗中得到。不同的試驗藥物副作用之盛行率差異頗大。服用抗生素者比服用安慰劑者經歷程更多的副作用(勝算比 2.37, 95% 信用區間 1.50 to 3.75)。 抗生素治療可以減短腹瀉的持續時間但會有更高的機率產生副作用。這些試驗應該報告利用“時間至事件” 來分析治療後腹瀉的持續時間之結果，但均未報告。 本摘要由三軍總醫院溫旻杰翻譯。 此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。 抗生素治療減少旅遊者腹瀉的持續時間及嚴重度。腹瀉對旅遊者來說是一個常見的問題，特別是旅遊者從已開發國家前進到開發中的國家時。這一種疾病常常是細菌感染所造成的。雖然不太可能會造成死亡，腹瀉可能會中斷旅遊計畫和導致嚴重或者失能的症狀。這一篇回顧顯示抗生素治療縮短腹瀉的持續時間及降低嚴重程度。服用抗生素發生較多的副作用，但是大部分的副作用是輕微的或者是停止使用抗生素後便會消失。