Active substances: Norfloxacin
Search Menu Abstract The usefulness of fluoroquinolones for the treatment of mixed aerobic and anaerobic infections has been investigated since these agents started being used in clinical practice.
Hence, the findings above only represent a fraction of all travel-related cases of diarrhea in Canada. Methods This statement was developed by a working group comprised of volunteers from the CATMAT committee, none of whom declared a relevant conflict of interest.
The working group, with support from the secretariat, was responsible for: literature retrieval, synthesis and analysis; and the development of key questions and draft recommendations.
Recommendations in this statement on interventions to prevent and treat TD were developed using the GRADE methodology, wherever relevant and feasible.
This approach has been increasingly adopted by guideline developers Reference 22, Reference 23. It stresses transparency and provides an explicit framework in which the following factors are considered and weighed when making a recommendation s: confidence in the estimate of effect quality of data, see Box 1: FAQ on pg.
Resulting recommendations are expressed as strong or conditional see Box 1: FAQ on pg.
Various recommendations for preventive and treatment interventions provided within this statement include off-label use of medications. Product monographs or other similarly approved standards or instructions for use should be reviewed prior to use.
Key questions to define the magnitude of benefits and harms were also identified: What harms are associated with TD chemoprophylactic and therapeutic agents, as well as with vaccination?
What are the important risk factors for TD among travellers e. What are the values and preferences of travellers regarding the magnitude of risk reduction in TD that would make use of the relevant intervention worthwhile given the associated cost and inconvenience?
With the aid of a reference librarian, a strategy was developed to identify relevant literature.
See Appendix 1 for an example of a search strategy used. Reference lists from relevant studies were also scanned to identify any studies not captured by the database searches.
From these searches, literature addressing the population of interest, intervention, comparison and outcome "PICO" and other questions was identified. Systematic reviews that addressed the efficacy and safety of the TD interventions were specifically sought out.
Although some studies evaluated prevention and treatment of mild or moderate TD, our recommendations only addressed outcomes using the classical definition of TD: three or more unformed stools with at least one enteric symptom within a 24 hour period.
For studies evaluating antibiotics and vaccine, those conducted in a non-traveller population were also excluded. For antisecretory and antimotility studies, non-traveller populations were considered in situations where traveller data were scarce, but their inclusion in the analysis led to a rating down in the overall quality of evidence.
Finally, several studies were excluded that evaluated antibiotics which are either no longer available in Canada or are no longer prescribed for TD due to widespread antibiotic resistance.
A quality assessment of studies evaluating the efficacy of each of the TD interventions was performed, and results were collated into evidence profiles and summary of findings tables see Appendix 2 as per the GRADE methodology Reference 24-26.
Recommendations were developed for use of each TD intervention, taking into consideration: our confidence in the estimates of the efficacy and harms of each intervention, the balance of harms and benefits, and the values and preferences of travellers.
The cost of each intervention, normally borne by the traveller, was not explicitly considered as there were no data available on willingness to pay WTP for TD in travellers.
The evaluation of certain interventions is not amenable to the GRADE approach, either due to lack of credible alternatives to the intervention in question i. As such, CATMAT provided recommendations for these interventions based on a review of the literature, as well as expert opinion.