Guidelines for the prevention and treatment of travelers’ diarrhea: a graded expert panel report

Abstract

: Prevention and treatment of travelers' diarrhea requires action at the provider, traveler and research community levels. Strong evidence supports the effectiveness of antimicrobial therapy in most cases of moderate to severe travelers' diarrhea, while either increasing intake of fluids only or loperamide or bismuth subsalicylate may suffice for most cases of mild diarrhea. Further studies are needed to address knowledge gaps regarding optimal therapies, the individual, community and global health risks of MDR acquisition, manipulation of the microbiome in prevention and treatment and the utility of laboratory testing in returning travelers with persistent diarrhea.

Microbiome and Antimicrobial Resistance Gene Dynamics in International Travelers

“…In addition to β-lactamase genes, mNGS identified a diversity of other AMR gene classes that increased in abundance after travel. For example, 80% of participants acquired horizontally transferable qnr genes after travel, reflecting the limited utility of quinolones for treatment of traveler’s diarrhea ( 12 ). Although we did not detect genes known to encode carbapenemases, participants might have harbored carbapenem-resistant Enterobacteraciae , given that a combination of an ESBL or AmpC gene with a porin mutation or efflux pump can lead to carbapenem resistance ( 13 ).…”

Carbapenemase-producing Enterobacteriaceae in a group of Polish travelers returning from South and South-East Asia, June 2017 – June 2018. Environment- or healthcare-associated?

“…Travellers' diarrhea (TD) is one of the most common causes of hospitalization after returning from international trips, and is characterized by three factors: susceptibility to enteric bacteria, viruses and parasites, residence in a developing country, and travel to a tropical or semi-tropical region with a low level of hygiene [18,19]. Differential diagnosis should be considered in moderate and severe TD cases [20]. Furthermore, 5-10% of patients with travellers' diarrhea develop chronic functional bowel diseases or post-infectious irritable bowel syndrome [19].…”

Acute Illness in the Athlete

“…If prophylaxis is needed for an athlete, rifaximin is the antibiotic currently recommended at either 200 mg daily, twice daily, or 3 times daily because of a much lower side effect profile than the fluoroquinolones. 43 Before travel to high-risk regions, athletes should be educated on prudent selection of food and drinks. Selecting only bottled water or carbonated canned drinks, both consumed from the bottle with a straw rather than from a glass, as well as only eating fully cooked hot food and fruit that is peeled by the eater can minimize risk.…”