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Antimicrobial Agents and Chemotherapy, January 2001, p. 212-216, Vol. 45, No. 1
0066-4804/01/$04.00+0   DOI: 10.1128/AAC.45.1.212-216.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

In Vitro Antimicrobial Susceptibility Testing of Bacterial Enteropathogens Causing Traveler's Diarrhea in Four Geographic Regions

Harumi Gomi,1 Zhi-Dong Jiang,1 Javier A. Adachi,1 David Ashley,2 Brett Lowe,3 Mangala P. Verenkar,4 Robert Steffen,5 and Herbert L. DuPont*,1,6

Center for Infectious Diseases, University of Texas-Houston Medical School and School of Public Health,1 and St Luke's Episcopal Hospital and Baylor College of Medicine,6 Houston, Texas; Western Area Health Administration, Ministry of Health of Jamaica, Kingston, Jamaica2; Kenya Medical Research Institute, Clinical Research Institution, Kilifi, Kenya3; Goa Medical College, Bambolin, Goa, India4; and University of Zurich Travel Clinic, Zurich, Switzerland5

Received 17 July 2000/Returned for modification 15 September 2000/Accepted 6 October 2000

The emergence of resistant enteropathogens has been reported worldwide. Few data are available on the contemporary in vitro activities of commonly used antimicrobial agents against enteropathogens causing traveler's diarrhea (TD). The susceptibility patterns of antimicrobial agents currently available or under evaluation against pathogens causing TD in four different areas of the world were evaluated. Pathogens were identified in stool samples from U.S., Canadian, or European adults (18 years of age or older) with TD during 1997, visiting India, Mexico, Jamaica, or Kenya. MICs of 11different antimicrobials were determined against 284 bacterial enteropathogens by the agar dilution method. Ciprofloxacin, levofloxacin, ceftriaxone, and azithromycin were highly active in vitro against the enteropathogens, while traditional antimicrobials such as ampicillin, trimethoprim, and trimethoprim/sulfamethoxazole showed high levels and high frequencies of resistance. Rifaximin, a promising and poorly absorbable drug, had an MIC at which 90% of the strains tested were inhibited of 32 µg/ml, 250 times lower than the concentration of this drug in the stools. Amdinocillin, nalidixic acid, and doxycycline showed moderate activity. Fluoroquinolones are still the drugs of choice for TD in most regions of the world, although our study has a limitation due to the lack of Escherichia coli samples from Kenya and possible bias in selection of the patients for evaluation. Azithromycin and rifaximin should be considered as promising new agents. The widespread in vitro resistance of the traditional antimicrobial agents reported since the 1980s and the new finding of resistance to fluoroquinolones in Southeast Asia are the main reasons for monitoring carefully the antimicrobial susceptibility patterns worldwide and for developing and evaluating new antimicrobial agents for the treatment of TD.

* Corresponding author. Mailing address: St. Luke's Episcopal Hospital, 6720 Bertner Ave, MC 1-164, Houston, TX 77030. Phone: (713) 791-4122. Fax: (713) 791-4167. E-mail: mhld01{at}sleh.com.

Antimicrobial Agents and Chemotherapy, January 2001, p. 212-216, Vol. 45, No. 1
0066-4804/01/$04.00+0   DOI: 10.1128/AAC.45.1.212-216.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.


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