Review - Document Details


Review - Reviewer's Assessment

1. Short summary / abstract
The Cochrane Collaboration Trials Register, MEDLINE, and EMBASE were searched. Additional trials were identified by hand searching. Content experts were contacted. Selection Criteria: All trials in any language in which travellers older than 5 years were randomly allocated to treatment for acute non-bloody diarrhoea with antibiotics and where the causative organism is not known at allocation. Data collection and analysis: Two reviewers assessed trial quality and extracted data. Main Results: Twelve placebo-controlled studies met inclusion and quality criteria for inclusion. A meta-analysis for the primary outcome was not feasible. All of the 10 trials reported a significant reduction in duration of diarrhoea in participants treated with antibiotics compared with placebo. Data from two trials demonstrated a small reduction for antibiotic treated patients in the number of unformed stools passed per each 24 hour period from randomisation up to 72 hours. Data from six trials demonstrated a greater number of participants being cured of diarrhoea by 72 hours (odds ratio [OR] 5.9, 95% confidence interval [CI] 4.06 to 8.57). Data regarding side effects were available from five trials. There was wide variation in the prevalence of side effects reported in different trials. Persons taking antibiotics experienced more side effects than those taking placebo (OR 2.37, 95% CI 1.5 to 3.75). Reviewers' conclusions: Antibiotic treatment is associated with shorter duration of diarrhoea but higher incidence of side-effects. Trials generally do not report duration of post-treatment diarrhoea using time-to-event analyses, and should do.

2. What question is the document addressing?
The aims of this review were to assess the effects of antibiotics on traveller's diarrhoea in relation to duration of illness, severity of illness, and adverse effects of medications.

3. Type of study
Systematic review

4. Methods valid & appropriate?

The search strategy was very comprehensive and each paper was critically assessed by two reviewers to ensure the quality of included studies.

5. Results / recommendations reliable?
No meta-analysis could be performed for the primary outcome, duration of diarrhoea. However, all but one of the individual studies indicated a benefit from antibiotics.

6. Any major problems and biases?
Six studies which were identified were awaiting further evaluation (three in German, two unpublished, one abstract). It is unknown what effect the inclusion of these studies would have had on the overall results.

7. Any other important / relevant studies which confirm or contradict?
A more recent search for studies, conducted in January 2002 for Clinical Evidence 7, found only one extra study. The conclusion was in agreement with this systematic review.

8. Keywords

Reviewer's Details:

Name:Tim Weller
Post:Consultant Microbiologist
(Society / Organisation / Advisory Committee):

*** Note: These are the views of a professional expert rather than an official statement from his or her society, organisation or advisory committee.

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