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Disclaimer: CME certification for these activities has expired. All information is pertinent to the timeframe in which it was released.


Meeting the Challenges in the Management of Infectious Diarrhea


GOAL
To provide gastroenterologists and primary care physicians with an update on the most current treatment options regarding the treatment of infectious diarrhea.

TARGET AUDIENCE
This activity is designed for gastroenterologists and primary care physicians. No prerequisites required.

LEARNING OBJECTIVES
The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity. At the conclusion of this activity, participants should be able to:

  • Recognize the potential long-term sequelae of acute episodes of infectious diarrhea.
  • Discuss the limitations of current antibiotic therapy for infectious diarrhea, especially as they relate to special patient populations.
  • Discuss the potential role of nonabsorbable antibiotics in the treatment of patients with infectious diarrhea.
  • Evaluate the available data regarding the efficacy and limitations of nonabsorbable antibiotics in treating infectious diarrhea.

ACCREDITATION STATEMENT
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 1 category 1 credit toward the AMA Physician's Recognition Award. Each physician should only claim those hours of credit that he/she actually spent in the activity.

The estimated time to complete this educational activity: 1 hour.

Release date: November 15, 2003. Expiration date: November 15, 2005.

DISCLAIMER STATEMENT
The opinions and recommendations expressed by faculty and other experts whose input is included in this program are their own. This enduring material is produced for educational purposes only. Use of Johns Hopkins University School of Medicine name implies review of educational format design and approach. Please review the complete prescribing information of specific drugs or combinations of drugs, including indications, contraindications, warnings, and adverse effects, before administering pharmacologic therapy to patients.

This program is supported by an unrestricted educational grant from Salix Pharmaceuticals, Inc.

Advanced Studies in Medicine (ISSN-1530-3004) is published by Galen Publishing, a division of Advanced Studies in Medicine, an HMG Company. PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2003 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. Advanced Studies in Medicine is a registered trademark of The Healthcare Media Group, LLC.

Full Disclosure Policy Affecting CME Activities:
As a sponsor accredited by the Accreditation Council for Continuing Medical Education (ACCME), it is the policy of Johns Hopkins University School of Medicine to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. The Program Director and Participating Faculty reported the following:

PROGRAM DIRECTOR

    David N. Taylor, MD
    Research Professor
    Department of International Health
    Johns Hopkins University
    Bloomberg School of Public Health
    Baltimore, Maryland
    • Dr Taylor reports receiving grants and / or research support and honoraria from, and serving as a consultant to Salix Pharmaceuticals, Inc.

PARTICIPATING FACULTY

    Herbert L. DuPont, MD
    Chief of Internal Medicine
    St Luke's Episcopal Hospital
    Director, Center of Infectious Diseases
    University of Texas - Houston School of Public Health
    Vice Chairmen, Department of Medicine
    Baylor College of Medicine
    Houston, Texas
    • Dr DuPont reports receiving grants and / or research support and honoraria from Salix Pharmaceuticals, Inc.

    Robert Steffen, MD
    Professor of Travel Medicine
    Head, Division of Epidemiology and Prevention of Communicable Diseases
    University of Zurich
    Zurich, Switzerland
    • Dr Steffen reports receiving grant and / or research support and honoraria from, and serving as a consultant to Salix Pharmaceuticals, Inc.

Notice:
In accordance with the ACCME Standards for Commercial Support, the audience is advised that one or more articles in this continuing medical education activity contains reference(s) to unlabeled or unapproved uses of drugs or devices. The following faculty members have disclosed that their articles have referenced the following unlabeled/unapproved uses of drugs or devices:

Drs DuPont, Steffen, and Taylor - Rifaximin for the treatment of infectious diarrhea

Advanced Studies in Medicine provides disclosure information from contributing authors, lead presenters, and participating faculty. Advanced Studies in Medicine does not provide disclosure information from authors of abstracts and poster presentations. The reader shall be advised that these contributors may or may not maintain financial relationships with pharmaceutical companies.

Nonabsorbable Oral Antibiotic Therapy for Infectious Diarrhea
Herbert L. DuPont, MD*

Acute infectious diarrhea caused by bacteria remains a common problem associated with significant morbidity and mortality in the United States and throughout the world. The usefulness of currently available antibiotics for infectious diarrhea is limited by shortcomings, including bacterial resistance, poor tolerability, and lack of utility in vulnerable patient groups, such as the elderly, young children, and pregnant or potentially pregnant women. In 1993, on the basis of promising data with the nonabsorbable antibiotics aztreonam and bicozamycin in infectious diarrhea, Dr Charles Ericsson and I postulated in an article in the New England Journal of Medicine that nonabsorbable oral antibiotic therapy could overcome some of the limitations of the currently available antimicrobials.1 Nonabsorbable oral antibiotics, unlike systemically available antibiotics, offer the advantages of localized enteric targeting of pathogens, minimal or no risk of systemic toxicity or side effects, and circumscribed (enteric only) use, which may limit the development of widespread bacterial resistance. Unfortunately, despite these potential advantages, neither aztreonam nor bicozamycin was developed for use in infectious diarrhea-perhaps because the unmet needs in enteric antibacterial therapy were not as pressing as they are now.

Now, 10 years after the appearance of that article, the pending introduction of the nonabsorbed (<0.5%) antibiotic rifaximin in the United States provides another opportunity to assess the potential usefulness of nonabsorbed antibiotics in the treatment of infectious diarrhea. This monograph comprises 2 articles based on the proceedings of a meeting of infectious disease specialists and gastroenterologists convened in February 2003 in Dallas, Texas, to discuss the most current issues in the management of infectious diarrhea and other enteric bacterial illnesses. In the first article, "Community-Acquired Diarrheal Disease in Western Countries: Applications of Nonabsorbable Oral Antibiotic Therapy," I consider how nonabsorbable antibiotic therapy may meet several specific challenges in the management of infectious diarrhea. I also briefly consider the potential role of nonabsorbable antibiotics in antibioterrorist initiatives. In the second article, "The Emerging Role of Nonabsorbable Oral Antibiotic Therapy in the Management of Travelers' Diarrhea," Dr Robert Steffen reviews clinical and microbiologic data relevant to determining the role of nonabsorbable antibiotic therapy in the management of travelers" diarrhea, which is a subtype of infectious diarrhea. Dr Steffen and I attempt to present a comprehensive assessment of both the strengths and weakness of nonabsorbed antibiotic therapy for infectious diarrhea. We hope that our assessment stimulates thought and is useful in a practical sense to healthcare practitioners who provide care for patients with infectious diarrhea.

REFERENCES
1. DuPont HL, Ericsson CD. Prevention and treatment of traveler's diarrhea. N Engl J Med. 1993;328(25):1821-1827.

*Chief of Internal Medicine, St Luke's Episcopal Hospital; Director, Center for Infectious Diseases, University of Texas - Houston School of Public Health; Vice Chairman, Department of Medicine, Baylor College of Medicine, Houston, Texas.





Johns Hopkins Advanced Studies in Medicine (ISSN-1558-0334), is published by Galen Publishing, LLC, d/b/a ASiM, PO Box 340, Somerville, NJ 08876. (908) 253-9001. Copyright ©2012 by Galen Publishing. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, without first obtaining permission from the publisher. ASiM is a registered trademark of The Healthcare Media Group, LLC.