From the Guidelines
Travelers' diarrhea is best managed through prevention and prompt treatment, with a focus on oral rehydration, antimicrobial therapy, and symptom management, as recommended by the most recent guidelines 1. To prevent travelers' diarrhea, it is essential to drink only bottled or purified water, avoid raw foods, and practice good hand hygiene while traveling. If symptoms develop, oral rehydration is crucial - drink plenty of fluids with electrolytes. For treatment, bismuth subsalicylate (Pepto-Bismol) can be taken as 2 tablets (262 mg each) four times daily for 2 days. For more severe cases, loperamide (Imodium) 4 mg initially followed by 2 mg after each loose stool (maximum 16 mg daily) can help reduce frequency. However, due to increasing antibiotic resistance among common bacterial enteropathogens, including fluoroquinolone resistance 1, antibiotics may need to be selected carefully, with azithromycin 1000 mg as a single dose being a potential option for moderate to severe cases. Seek medical attention if you experience high fever, bloody stools, severe abdominal pain, or symptoms lasting more than 3-5 days. Travelers' diarrhea occurs when you're exposed to unfamiliar bacteria, viruses, or parasites that your digestive system isn't accustomed to, with enterotoxigenic E. coli being the most common cause. Some key considerations in managing travelers' diarrhea include:
- The use of antimicrobial agents, such as antibiotics, should be guided by the severity of symptoms and the likelihood of bacterial etiology 1.
- The increasing prevalence of antibiotic-resistant pathogens, such as fluoroquinolone-resistant Campylobacter, highlights the need for careful selection of empiric therapy 1.
- Oral rehydration and symptom management are essential components of treatment, regardless of the severity of symptoms 1.
From the FDA Drug Label
Infectious Diarrhea caused by Escherichia coli (enterotoxigenic strains), Campylobacter jejuni, Shigella boydii†, Shigella dysenteriae, Shigella flexneri or Shigella sonnei† when antibacterial therapy is indicated.
Ciprofloxacin is indicated for the treatment of infectious diarrhea caused by certain bacteria, including Escherichia coli (enterotoxigenic strains), Campylobacter jejuni, and Shigella species. Key points to consider:
- Traveler's diarrhea is often caused by enterotoxigenic Escherichia coli.
- Ciprofloxacin may be used to treat traveler's diarrhea when antibacterial therapy is indicated 2.
From the Research
Definition and Prevalence of Travelers Diarrhea
- Travelers' diarrhea (TD) is the most important health issue among international travelers, affecting 50-90% of travelers in high-risk areas 3.
- The risk of acquiring TD is influenced by factors such as destination, duration of stay, standard of accommodation, type of travel, age of the traveler, and individual risk factors 3.
- Between 10% and 40% of travelers develop diarrhea, with the attack rate being highest for travelers from developed countries visiting developing countries 4.
Causes and Complications of Travelers Diarrhea
- Most cases of TD are caused by bacterial pathogens, commonly Escherichia coli 3, 4.
- Dehydration is the most common complication of TD 4.
- Children are at particular risk of developing TD 4.
Treatment and Prevention of Travelers Diarrhea
- Treatment for TD includes loperamide and antibiotics, such as azithromycin, fluoroquinolones, and rifaximin 3, 4, 5, 6.
- For mild TD, the use of antibiotic is not recommended, but bismuth subsalicylate or loperamide may be considered 4.
- For moderate TD, antibiotics such as fluoroquinolones, azithromycin, and rifaximin may be used, and loperamide may be considered as monotherapy or adjunctive therapy 4.
- Preventive strategies such as hygiene measures have limited impact, but pretravel education on hygiene and safe selection of food items is important in minimizing episodes 3, 4, 6.
- Chemoprophylaxis should be restricted to travelers who are at risk of severe complications of diarrhea 6.
- Loperamide plus azithromycin has been shown to be more effective than azithromycin alone in treating TD 7.