Stand-by antibiotics encourage unwarranted use of antibiotics for travelers' diarrhea : A prospective study

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Vilkman , K , Lääveri , T , Pakkanen , S H & Kantele , A 2019 , ' Stand-by antibiotics encourage unwarranted use of antibiotics for travelers' diarrhea : A prospective study ' , Travel medicine and infectious disease , vol. 27 , pp. 64-71 . https://doi.org/10.1016/j.tmaid.2018.06.007

Titel: Stand-by antibiotics encourage unwarranted use of antibiotics for travelers' diarrhea : A prospective study
Författare: Vilkman, Katri; Lääveri, Tinja; Pakkanen, Sari H.; Kantele, Anu
Upphovmannens organisation: Department of Bacteriology and Immunology
University of Helsinki
Medicum
Infektiosairauksien yksikkö
Clinicum
Department of Medicine
Anu Kantele-Häkkinen Research Group
HUS Inflammation Center
Datum: 2019
Språk: eng
Sidantal: 8
Tillhör serie: Travel medicine and infectious disease
ISSN: 1477-8939
DOI: https://doi.org/10.1016/j.tmaid.2018.06.007
Permanenta länken (URI): http://hdl.handle.net/10138/299322
Abstrakt: 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.
Subject: Travelers' diarrhea
Stand-by antibiotics
Travel
Severe TD
Incapacitating TD
Antimicrobial resistance
LACTAMASE-PRODUCING ENTEROBACTERIACEAE
SELF-TREATMENT
COLONIZATION
LOPERAMIDE
RISK
ABROAD
COHORT
3121 General medicine, internal medicine and other clinical medicine
3111 Biomedicine
Referentgranskad: Ja
Licens: cc_by_nc_nd
Användningsbegränsning: openAccess
Parallelpublicerad version: publishedVersion


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