From the Guidelines
Travelers' diarrhea typically presents as sudden onset of loose, watery stools, often accompanied by abdominal cramps, nausea, bloating, and occasionally fever or blood in stool, with most people experiencing 3-5 loose bowel movements per day. The symptoms usually begin within the first week of travel, often within the first few days after arrival in a new location. Dehydration signs may develop, including increased thirst, dry mouth, decreased urination, dizziness, and weakness. Most cases are caused by bacterial pathogens like E. coli, though viruses and parasites can also be responsible.
Common Symptoms
- Sudden onset of loose, watery stools
- Abdominal cramps
- Nausea
- Bloating
- Fever or blood in stool
- Urgent bowel movements
- Vomiting
- General malaise or fatigue The condition typically resolves on its own within 3-5 days, but can persist longer depending on the cause.
Severe Symptoms
Severe symptoms such as high fever (over 102°F/39°C), bloody diarrhea, severe abdominal pain, or signs of significant dehydration warrant immediate medical attention, as these may indicate a more serious infection requiring specific treatment 1.
Treatment
For mild diarrhea, the traveler is encouraged to use supportive measures such as rehydration and non-antibiotic, anti-motility drugs such as loperamide, with a starting dose of 2 tablets (4 mg), followed by 2 mg after each additional loose or liquid stool, up to a total dose of 16 mg per day. If diarrhea worsens or is accompanied by moderate-severe or invasive symptoms, then antibiotics such as azithromycin should be used 1. It is essential to counsel the traveler on the proper use of antibiotics and the potential risks of antibiotic resistance, as well as the importance of rehydration and rest in managing travelers' diarrhea 1.
From the Research
Symptoms of Traveler's Diarrhea
- The symptoms of traveler's diarrhea can vary depending on the causative agent, but common symptoms include diarrhea, abdominal cramps, and dehydration 2.
- The onset of illness, symptoms experienced, and the duration of symptoms are greatly impacted by the causative agent 3.
- Enterotoxigenic Escherichia coli is the most common pathogen isolated in cases of traveler's diarrhea, followed by Campylobacter species 4, 5.
Common Complications
- Dehydration is the most common complication of traveler's diarrhea 2.
- Other complications can include electrolyte imbalances, malabsorption, and weight loss.
Treatment Options
- For mild traveler's diarrhea, the use of antibiotic is not recommended, but the use of bismuth subsalicylate or loperamide may be considered 2.
- For moderate traveler's diarrhea, antibiotics such as fluoroquinolones, azithromycin, and rifaximin may be used, and loperamide may be considered as monotherapy or adjunctive therapy 2, 4, 5.
- For severe traveler's diarrhea, antibiotics such as azithromycin, fluoroquinolones, and rifaximin should be used, and azithromycin can be used even for the treatment of dysentery 2.
Treatment Efficacy
- The combination of loperamide and some antimicrobials has proven to be more efficacious than the antimicrobial agent alone in the treatment of traveler's diarrhea 5, 6.
- A single 500 mg dose of azithromycin appeared as effective as a 1,000 mg dose for the treatment of travelers' diarrhea in an Escherichia coli predominant region of the world 5.
- Loperamide plus 500 mg of azithromycin was safe and more effective than either dose of azithromycin alone for the treatment of travelers' diarrhea 5.