A double blind, randomized, placebo-controlled study of SP-303 (Provir) in the symptomatic treatment of acute diarrhea among travelers to Jamaica and Mexico.

OBJECTIVE: The study was designed to evaluate the effectiveness of SP-303 (Provir), a plant-derived product with novel antisecretory properties, in the treatment of travelers' diarrhea. METHODS: A total of 184 persons from the United States who acquired diarrhea in Jamaica or Mexico were enrolled in a double-blind, placebo-controlled study examining the effectiveness of three doses of SP-303 in reducing illness. Subjects were treated with 125 mg, 250 mg, or 500 mg SP-303 or a matching placebo four times a day for 2 days. Subjects kept daily diaries of symptoms and were seen each day for 3 days. Of the subjects, 169 (92%) were included in the efficacy analysis. RESULTS: The most common etiological agent identified was enterotoxigenic Escherichia coli, found in 19% of subjects. The mean time interval from taking the first dose of medication until passage of the last unformed stool during 48 h therapy (TLUS48) was 38.7 h for the placebo group. TLUS48 was shortened by SP-303: 30.6 h for the 125-mg dose group (p = 0.005); 30.3 h for the 250-mg group; and 32.6 h for the 500-mg group (p = 0.01). Treatment failures were seen in 29.3% in the placebo group compared with 7.3% (p = 0.01), 4.3 (p = 0.002), and 9.8 (p = 0.026) in the three treatment groups. SP-303 was well tolerated at all doses. CONCLUSIONS: SP-303 was effective in shortening the duration of travelers' diarrhea by 21%. This antisecretory approach works directly against the pathophysiology of travelers' diarrhea and is not likely to potentiate invasive forms of diarrhea or to produce posttreatment constipation.

Enteric pathogens in Mexican sauces of popular restaurants in Guadalajara, Mexico, and Houston, Texas.

BACKGROUND: The transmission of traveler's diarrhea is primarily foodborne. OBJECTIVE: To examine the level of microbial contamination of tabletop sauces found in Mexican-style restaurants. DESIGN: Cross-sectional study of Mexican sauces. SETTING: Mexican restaurants in Guadalajara, Mexico, and Houston, Texas, during the summer of 1998. MEASUREMENTS: 71 sauces from Guadalajara and 25 sauces from Houston were examined. The number of sauces contaminated with Escherichia coli, the median number of E. coli colonies per gram of sauce, and enteropathogens were identified. RESULTS: 47 of 71 sauces from Guadalajara were contaminated with E. coli versus 10 of 25 sauces from Houston (P = 0.03); the median number of E. coli colonies per gram of sauce was 1000 in the Guadalajara sauces versus 0.0 in the Houston sauces (P = 0.007). Among sauces from Guadalajara tested for diarrheogenic E. coli, 4 of 43 sauces contained enterotoxigenic E. coli and 14 of 32 contained enteroaggregative E. coli. CONCLUSIONS: Contamination with E. coli was common in samples of Mexican tabletop sauces from Guadalajara restaurants. These sauces commonly contained enteric pathogens.

Enteroaggregative Escherichia coli as a cause of traveler's diarrhea: clinical response to ciprofloxacin

The purpose of this study was to determine the role of enteroaggregative Escherichia coli (EAEC) in the development of traveler's diarrhea and the clinical response of patients with EAEC diarrhea following treatment with ciprofloxacin. Sixty-four travelers with diarrhea and no other recognized enteropathogen were enrolled in treatment studies in Jamaica and Mexico from July 1997 to July 1998. EAEC was isolated from 29 travelers (45.3 percent). There was a significant reduction in the duration of posttreatment diarrhea in the 16 patients treated with ciprofloxacin, as compared with that in the 13 patients who received placebo (mean of 35.3 versus 55.5 hours; P= .049). There was a nonsignificant reduction in the mean number of unformed stools passed during the 72 hours after enrollment in the ciprofloxacin-treated group (7.5) (P= .128). This study provides additional evidence that EAEC should be considered as a cause of antibiotic-responsive traveler's diarrhea. (AU)