Editorial Commentary:Loperamide for the Treatment of Traveler’s Diarrhea: Broad or Narrow Usefulness?

Abstract

by anaerobic bacteria in the intestine, is to give more-prolonged and higher drug concentrations in the intestinal lumen, with less absorption into the blood, potentially causing fewer systemic adverse effects, such as CNS depression, than when loperamide hydrochloride is administered. Clinical studies in the meta-analysis enrolled young US students or military personnel in prospective randomized trials in Mexico, Thailand, and Egypt. The most common microbial cause of diarrhea identified in study participants were enterotoxigenic Escherichia coli, followed by Shigella species, Campylobacter species, Salmonella species, enteroaggregative E. coli, Giardia lamblia, Entamoeba histolytica, and Cryptosporidium species. Pathogenesis of traveler’s diarrhea occurs at the epithelial cell surface of the intestine, where enterotoxins cause fluid production or invasive pathogens elicit inflammation. Neural signals are transmitted from this surface to smooth muscle to increase peristalsis, giving rise to symptoms of cramps and frequent bowel movements. Traveler’s diarrhea is unique for a high attack rate because of a low level of immunity in travelers against prevalent pathogens in the food and water from the visited countries. Travelers are also a selected population of usually young, healthy adults who develop mild or moderately severe nondehydrating