Prevention of gastrointestinal infections in India

Nick-H · Dec 1st, 2006, 11:42

Poor Mrs N is in bed. And when she is not in bed she is in the toilet

The only thing she ate yesterday that I didn't (I had a tiny taste only) was one of those little ice-cream pots.

So there you are, folks: a native Indian, with a native Indian immune system, grounded by icecream. Let it be a warning to us all

.

The pharmacy has sent this Tinidazole and Norfloxacin thing that GGG mentioned. They only sent two pills: isn't this an antibiotic that one should take at least a three-day course?

Awareness of the dangers of anti-biotic misuse her is low to zero.

SANJAY_DEL · Dec 1st, 2006, 11:47

Norfloxacin-tinidazole combination must be taken twice a day for at least 3 to 5 days.
A better combination is Ofloxacin-Ornidazole ( brands like Orni-O and Zorno ) which is more effective, with fewer side effects.

drzog · Dec 2nd, 2006, 17:35

Sorry SanJay I disagree that there is a "must" be taken for 3 days, they are often effective as a single dose, and it is dependnat on the nature of the infection.

Time for the herbs and probiotics hmm

SANJAY_DEL · Dec 2nd, 2006, 17:40

Dr Zog, single doses of an antibiotic may be temporarily effective, but is more likely to cause development of resistant strains of the bacteria which caused the infection.

drzog · Dec 2nd, 2006, 17:58

MIMS Abbreviated Prescribing Information

Tinidazole Pfizer Australia Pty Ltd

Section: 8(g) Other antibiotics and anti-infectives
Uses/Indications: Genitourinary T. vaginalis; giardiasis; amoebic dysentery/ hepatic abscess; surgical prophylaxis of anaerobic infections

Dose: Should be taken with food. Adults: 2 g as a single stat dose or for 2-3 days

Noroxin:

Resistance to norfloxacin due to spontaneous mutation is a rare occurrence (range: 10-9 to 10-12 cells). Resistant organisms have emerged during therapy with norfloxacin in less than 1% of patients treated. Organisms in which development of resistance is greatest are the following:

Pseudomonas aeruginosa
Klebsiella pneumoniae
Acinetobacter spp.
Enterococcus spp.

There is generally no cross-resistance between norfloxacin and other classes of antibacterial agents.

i have had excellent results with stat or 2 doses of noroxin. But then i take herbs and probiotics...despite this you should follow the advice of the treating Dr.

goangoangone · Dec 2nd, 2006, 18:00

On mine it said 2 a day for 5 days. Started the pre and pros today.

Ibizabum · Dec 5th, 2006, 01:04

I'm going to start taking these before I go and will have some with me but as I'm there for two months, need to take a lot of them.

Are they easy to come by in Goa, I am planning to buy the 10 billion strength.

Hope someone can help.

Cheers

SANJAY_DEL · Dec 5th, 2006, 01:25

I would again stress the need for prevention rather than use of drugs to pre-treat traveler's diarrhea, which may be viral in any case.
Prevention begins with dietary precautions. Travelers are advised specifically to avoid tap water, foods washed in water (such as salads), ice, unpasteurized milk, sauces and salsas, uncooked seafood, and raw or poorly cooked meats. Consuming foods purchased from street vendors carries a particularly high risk of TD. Safe foods and beverages include carbonated bottled beverages; food cooked and served piping hot; and dry foods, such as bread and cereal.

SANJAY_DEL · Dec 5th, 2006, 01:28

Are Probiotics Helpful?

Probiotics, defined as live microbial food supplements that beneficially affect the host animal by improving the GI microbial balance, have been tested as preventive agents against TD.[12] In small trials involving 50 American travelers to Mexico and British soldiers deployed to Belize, no benefit from Lactobacillus acidophilus, Lactobacillus fermentum, or Lactobacillus bulgaricus was demonstrated in the prevention of TD.[13,14]

Lactobacillus GG (LGG), however, distinguished by its resistance to sterilization by gastric acid and bile and its ability to adhere to and colonize bowel, has been found in 2 different trials to be more promising as a prophylactic agent for TD. One trial that investigated TD in Finns traveling to 2 destinations in Turkey found a protection rate of 8% in one of the destinations and 38.5% in the other.[15] A study evaluating LGG in 245 American travelers to various destinations in Asia, Africa, and South and Central America found a rate of protection from TD of 47%.[16] Both of these trials used once-daily dosing of LGG. Our PUNDIT (Prophylaxis Using Nonpathogenic Bacteria in the Prophylaxis of Diarrhea in Travelers) Trial aims to be the largest on the subject, with the goal of recruiting 500 to 1000 patients from multiple travel clinics. Using a 3-arm format, we will compare both once- and twice-daily dosing of LGG with placebo.

From medscape.com

Zeppy · Dec 5th, 2006, 04:26

Quote:

Originally Posted by SANJAY_DEL

Norfloxacin-tinidazole combination must be taken twice a day for at least 3 to 5 days.
A better combination is Ofloxacin-Ornidazole ( brands like Orni-O and Zorno ) which is more effective, with fewer side effects.

Some questions:
1. What are the side effects of both these drugs? (One in my party can't keep doxycycline down, so I have to be careful in choosing strong antibiotics.)
2. Can both of these drugs be had over the counter in India, without a prescription? (Not so here, so I'm considering waiting till I have my one day in Delhi. Good idea, or not?)
3. What do they cost in India?
4. I've read that Cipro can be taken for dysentery. True? How does sit compare to the other two? (The doxycycline-intolerant one manages to take cipro.)
5. Is there any drug or herbal remedy that relieves stomach cramps?

Nick-H · Dec 5th, 2006, 10:17

I am not a doctor but...

To my basic common sense it seems absurd to take any drug for something you don't yet have (not including, of course, those that are meant to be prophylactic).

This thread, particularly with the benefit of professional contributors, probably has some of the most useful information on this subject available --- I'm going to make it a sticky.

But I do feel people get overly hung up on what to do when I get the runs in India --- there is a pretty good chance it won't happen! (although I belong to the minority to whom it usually did happen

).

I would suggest that anyone who is heading for rural India should print out this thread. Everyone else would be better advised to consult a local doctor if and when needed!

Zeppy, that's my answer to almost all your questions: don't mess with self-prescribing especially with what you correctly describe as strong antibiotics --- go see a doctor.

Especially if you should be so wildly unlucky as to catch dysentery. This is a serious disease. I would guess it still kills people who can't get or afford medical treatment. It is not something to self diagnose, treat with a pill out of your travel kit, or to take a big-guns antibiotic for just because this attack of the runs just might be dysentery

Your hotel will have a doctor who will be only too happy to get a couple of hundred Rs extra for a 'tourist visit'.

This is a bit of a rant, sorry --- but the message (very general, not directed specifically to any contributor in this thread) is: get over this reluctance to go and see a doctor in India! They are accessible and cheap. If you want posh then even a visit to a specialist at a big-city private hospital will only cost you a few hundred.

So far as probiotics and stuff is concerned --- [Post edited in accordance with later pro advice] Last thing that I read was that a single-species lactobacili, given the vast range of gut flora, is not a lot of use, a pro-biotic that encourages friendly bug growth is better. Just passing on something I read: Doctors?

SANJAY_DEL · Dec 5th, 2006, 11:28

No benefit from Lactobacillus acidophilus, Lactobacillus fermentum, or Lactobacillus bulgaricus was demonstrated in the prevention of Traveler's Diarrhea in trials.
Lactobacillus GG (LGG) may be of some benefit.

SANJAY_DEL · Dec 5th, 2006, 11:31

Probiotics is NOT "something we can all do for our general health at any time". Just some living bacteria to restore the normal gut flora after infections or drug treatment. Talk to a doctor, guys.
Do not indulge in self medication.

Zeppy · Dec 5th, 2006, 15:03

Quote:

Originally Posted by Nick-H

get over this reluctance to go and see a doctor in India! They are accessible and cheap.

No reluctance at all! I'm thinking about the 25- and 30-hour train trips. It seems to me it would be good at least to have something to relieve the pain of cramps if one is so unlucky as to fall ill on a long train ride. And, it seems to me, having the antibiotic of choice in one's first-aid kit would also not be a bad idea in case it really is dysentery. Probably there will be a doctor or several on the train, whom one can see for a diagnosis. But surely they don't carry a satchel full of medicines? So, I still seek answers to my questions above.

SANJAY_DEL · Dec 5th, 2006, 15:47

For abdominal cramps, keep a few tablets of DICYCLOMINE handy, and take one as required.
For symptomatic relief of diarrhea, take one or two capsules of Loperamide(Imodium).
Always take ORS if you have vomiting or diarrhea. Electral or Wallyte are two Indian brands.

Dec 1st, 2006, 11:42	#31
Nick-H Moderator Join Date: Oct 2004 Location: Chennai, India Posts: 22,870	Poor Mrs N is in bed. And when she is not in bed she is in the toilet The only thing she ate yesterday that I didn't (I had a tiny taste only) was one of those little ice-cream pots. So there you are, folks: a native Indian, with a native Indian immune system, grounded by icecream. Let it be a warning to us all . The pharmacy has sent this Tinidazole and Norfloxacin thing that GGG mentioned. They only sent two pills: isn't this an antibiotic that one should take at least a three-day course? Awareness of the dangers of anti-biotic misuse her is low to zero. __________________ . IndiaMike Mod Team (The Grumpy One)

Dec 2nd, 2006, 17:35	#33
drzog Based On A True Story Join Date: Nov 2004 Location: Melbourne, Australia Posts: 95	Sorry SanJay I disagree that there is a "must" be taken for 3 days, they are often effective as a single dose, and it is dependnat on the nature of the infection. Time for the herbs and probiotics hmm __________________ yours in health http://drzog.blogspot.com

Dec 2nd, 2006, 18:00	#36
goangoangone More rice? Join Date: Aug 2004 Location: Goa Posts: 1,434	On mine it said 2 a day for 5 days. Started the pre and pros today. __________________ GoanGoan......here

Dec 5th, 2006, 01:04	#37
Ibizabum Member Join Date: Nov 2006 Location: Ibiza Posts: 28	Acidophilus I'm going to start taking these before I go and will have some with me but as I'm there for two months, need to take a lot of them. Are they easy to come by in Goa, I am planning to buy the 10 billion strength. Hope someone can help. Cheers

Dec 5th, 2006, 01:28	#39
SANJAY_DEL Account Closed Join Date: Nov 2006 Location: NEW DELHI, INDIA Posts: 1,353	Use of Probiotics Are Probiotics Helpful? Probiotics, defined as live microbial food supplements that beneficially affect the host animal by improving the GI microbial balance, have been tested as preventive agents against TD.[12] In small trials involving 50 American travelers to Mexico and British soldiers deployed to Belize, no benefit from Lactobacillus acidophilus, Lactobacillus fermentum, or Lactobacillus bulgaricus was demonstrated in the prevention of TD.[13,14] Lactobacillus GG (LGG), however, distinguished by its resistance to sterilization by gastric acid and bile and its ability to adhere to and colonize bowel, has been found in 2 different trials to be more promising as a prophylactic agent for TD. One trial that investigated TD in Finns traveling to 2 destinations in Turkey found a protection rate of 8% in one of the destinations and 38.5% in the other.[15] A study evaluating LGG in 245 American travelers to various destinations in Asia, Africa, and South and Central America found a rate of protection from TD of 47%.[16] Both of these trials used once-daily dosing of LGG. Our PUNDIT (Prophylaxis Using Nonpathogenic Bacteria in the Prophylaxis of Diarrhea in Travelers) Trial aims to be the largest on the subject, with the goal of recruiting 500 to 1000 patients from multiple travel clinics. Using a 3-arm format, we will compare both once- and twice-daily dosing of LGG with placebo. From medscape.com

Dec 1st, 2006, 11:47	#32
SANJAY_DEL Account Closed Join Date: Nov 2006 Location: NEW DELHI, INDIA Posts: 1,353	Norfloxacin-tinidazole combination must be taken twice a day for at least 3 to 5 days. A better combination is Ofloxacin-Ornidazole ( brands like Orni-O and Zorno ) which is more effective, with fewer side effects.

Dec 2nd, 2006, 17:40	#34
SANJAY_DEL Account Closed Join Date: Nov 2006 Location: NEW DELHI, INDIA Posts: 1,353	Dr Zog, single doses of an antibiotic may be temporarily effective, but is more likely to cause development of resistant strains of the bacteria which caused the infection.

Dec 2nd, 2006, 17:58	#35
drzog Based On A True Story Join Date: Nov 2004 Location: Melbourne, Australia Posts: 95	MIMS Abbreviated Prescribing Information Tinidazole Pfizer Australia Pty Ltd Section: 8(g) Other antibiotics and anti-infectives Uses/Indications: Genitourinary T. vaginalis; giardiasis; amoebic dysentery/ hepatic abscess; surgical prophylaxis of anaerobic infections Dose: Should be taken with food. Adults: 2 g as a single stat dose or for 2-3 days Noroxin: Resistance to norfloxacin due to spontaneous mutation is a rare occurrence (range: 10-9 to 10-12 cells). Resistant organisms have emerged during therapy with norfloxacin in less than 1% of patients treated. Organisms in which development of resistance is greatest are the following: Pseudomonas aeruginosa Klebsiella pneumoniae Acinetobacter spp. Enterococcus spp. There is generally no cross-resistance between norfloxacin and other classes of antibacterial agents. i have had excellent results with stat or 2 doses of noroxin. But then i take herbs and probiotics...despite this you should follow the advice of the treating Dr.

Dec 5th, 2006, 01:25	#38
SANJAY_DEL Account Closed Join Date: Nov 2006 Location: NEW DELHI, INDIA Posts: 1,353	I would again stress the need for prevention rather than use of drugs to pre-treat traveler's diarrhea, which may be viral in any case. Prevention begins with dietary precautions. Travelers are advised specifically to avoid tap water, foods washed in water (such as salads), ice, unpasteurized milk, sauces and salsas, uncooked seafood, and raw or poorly cooked meats. Consuming foods purchased from street vendors carries a particularly high risk of TD. Safe foods and beverages include carbonated bottled beverages; food cooked and served piping hot; and dry foods, such as bread and cereal.

Dec 5th, 2006, 10:17	#41
Nick-H Moderator Join Date: Oct 2004 Location: Chennai, India Posts: 22,870	Go See A Doctor! I am not a doctor but... To my basic common sense it seems absurd to take any drug for something you don't yet have (not including, of course, those that are meant to be prophylactic). This thread, particularly with the benefit of professional contributors, probably has some of the most useful information on this subject available --- I'm going to make it a sticky. But I do feel people get overly hung up on what to do when I get the runs in India --- there is a pretty good chance it won't happen! (although I belong to the minority to whom it usually did happen ). I would suggest that anyone who is heading for rural India should print out this thread. Everyone else would be better advised to consult a local doctor if and when needed! Zeppy, that's my answer to almost all your questions: don't mess with self-prescribing especially with what you correctly describe as strong antibiotics --- go see a doctor. Especially if you should be so wildly unlucky as to catch dysentery. This is a serious disease. I would guess it still kills people who can't get or afford medical treatment. It is not something to self diagnose, treat with a pill out of your travel kit, or to take a big-guns antibiotic for just because this attack of the runs just might be dysentery Your hotel will have a doctor who will be only too happy to get a couple of hundred Rs extra for a 'tourist visit'. This is a bit of a rant, sorry --- but the message (very general, not directed specifically to any contributor in this thread) is: get over this reluctance to go and see a doctor in India! They are accessible and cheap. If you want posh then even a visit to a specialist at a big-city private hospital will only cost you a few hundred. So far as probiotics and stuff is concerned --- [Post edited in accordance with later pro advice] Last thing that I read was that a single-species lactobacili, given the vast range of gut flora, is not a lot of use, a pro-biotic that encourages friendly bug growth is better. Just passing on something I read: Doctors? Last edited by Nick-H : Dec 5th, 2006 at 16:43. Reason: See following advice from the Docs on probiotics

Dec 5th, 2006, 11:28	#42
SANJAY_DEL Account Closed Join Date: Nov 2006 Location: NEW DELHI, INDIA Posts: 1,353	No benefit from Lactobacillus acidophilus, Lactobacillus fermentum, or Lactobacillus bulgaricus was demonstrated in the prevention of Traveler's Diarrhea in trials. Lactobacillus GG (LGG) may be of some benefit.

Dec 5th, 2006, 11:31	#43
SANJAY_DEL Account Closed Join Date: Nov 2006 Location: NEW DELHI, INDIA Posts: 1,353	Probiotics is NOT "something we can all do for our general health at any time". Just some living bacteria to restore the normal gut flora after infections or drug treatment. Talk to a doctor, guys. Do not indulge in self medication.

Dec 5th, 2006, 15:47	#45
SANJAY_DEL Account Closed Join Date: Nov 2006 Location: NEW DELHI, INDIA Posts: 1,353	For abdominal cramps, keep a few tablets of DICYCLOMINE handy, and take one as required. For symptomatic relief of diarrhea, take one or two capsules of Loperamide(Imodium). Always take ORS if you have vomiting or diarrhea. Electral or Wallyte are two Indian brands.

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