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Chapter 11 : Treatment and Prophylaxis of Gastroenteritis
Category: Clinical Microbiology
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This chapter reviews the characteristics of the quinolones that make them useful for the treatment of enteric infections, and the role of these agents in treating enteric infections. There are a limited number of case reports of quinolones causing arthralgia when used for longer periods. The majority of these have been in children with cystic fibrosis, which is known to be associated with arthralgia, or with the prolonged use of pefloxacin, which is the most potent of the quinolones in initiating arthropathy in animals. The chapter reviews the indications for quinolone use in specific enteric infections or clinical conditions. The study in which patients had the shortest duration of illness, however, was the only one that did not show a reduction in diarrhea duration. The efficacy of antimicrobial prophylaxis of traveler's diarrhea was well established by studies conducted starting in the 1970s with doxycycline, and then with trimethoprim-sulfamethoxazole. There have been at least six studies of fluoroquinolone prophylaxis of traveler's diarrhea. All six studies showed efficacy in reducing the incidence of diarrhea. The protection afforded by prophylaxis in these studies ranged from 76 to 100%, similar to what is found using nonquinolone agents. Still, if someone is going to a particularly high-risk area for a short time, prophylaxis with a fluoroquinolone is likely to markedly diminish the risk of traveler's diarrhea. Plesiomonas shigelloides is another putative cause of gastroenteritis, strains of which are almost all susceptible to quinolones.