Treatment of traveler's diarrhea with ciprofloxacin and loperamide

J Infect Dis. 1992 Mar;165(3):557-60. doi: 10.1093/infdis/165.3.557.


To determine the efficacy of loperamide given with long- and short-course quinolone therapy for treating traveler's diarrhea, 142 US military personnel were randomized to receive a single 750-mg dose of ciprofloxacin with placebo, 750 mg of ciprofloxacin with loperamide, or a 3-day course of 500 mg of ciprofloxacin twice daily with loperamide. Culture of pretreatment stool specimens revealed campylobacters (41%), salmonellae (18%), enterotoxigenic Escherichia coli (ETEC, 6%), and shigellae (4%). Of the participants, 87% completely recovered within 72 h of entry. Total duration of illness did not differ significantly among the three treatment groups, but patients in the 3-day ciprofloxacin plus loperamide group reported a lower cumulative number of liquid bowel movements at 48 and 72 h after enrollment compared with patients in the single-dose ciprofloxacin plus placebo group (1.8 vs. 3.6, P = .01; 2.0 vs. 3.9, P = .01). While not delivering a remarkable therapeutic advantage, loperamide appears to be safe for treatment of non-ETEC causes of traveler's diarrhea. Two of 54 patients with Campylobacter enteritis had a clinical relapse after treatment that was associated with development of ciprofloxacin resistance.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Campylobacter Infections / drug therapy
  • Ciprofloxacin / therapeutic use*
  • Diarrhea / drug therapy*
  • Double-Blind Method
  • Drug Therapy, Combination
  • Dysentery, Bacillary / drug therapy
  • Escherichia coli Infections / drug therapy
  • Humans
  • Loperamide / therapeutic use*
  • Military Personnel
  • Salmonella Infections / drug therapy
  • Thailand
  • Travel
  • United States


  • Ciprofloxacin
  • Loperamide