Clinical Treatment of Nondysentery Travelers’ Diarrhea During Deployment

Hawk, Douglas; Tribble, David R.; Riddle, Mark S.

doi:10.7205/milmed-d-09-00190

Cited by 11 publications

(8 citation statements)

References 46 publications

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“…This finding is true for diarrheal illness in an operational setting, in which there have been efforts to enhance awareness of antibiotic treatment and to use antibiotics earlier in the course of illness. 30 The rates of decreased work performance reported by persons with diarrhea and ILI were similar (46% versus 48%; P = 0.8).…”

Section: Discussionmentioning

confidence: 70%

Hotel Clinic-Based Diarrheal and Respiratory Disease Surveillance in U.S. Service Members Participating in Operation Bright Star in Egypt, 2009

Sebeny

Nakhla²,

Moustafa³

et al. 2012

The American Society of Tropical Medicine and Hygiene

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Abstract. We conducted clinic-based, influenza-like illness and diarrheal disease surveillance among U.S. service members participating in Operation Bright Star 2009. Epidemiologic data and samples were collected. Nasopharyngeal swab specimens were tested for viruses, and feces was tested for microbiologic, immunologic, and molecular diagnostics. A survey was used to collect self-reported data. From 1,529 surveys, 41% reported diarrheal disease and 25% reported respiratory illness (incidence rate = 62 of 100 versus 37 of 100 person-months; incidence rate ratio = 1.7, 95% confidence interval = 1.5-1.9). Enterotoxigenic Escherichia coli was identified in 74% (69 of 93) of fecal samples. In the influenzalike illness case series, 17% (9 of 52) were positive for influenza A; all were positive for pandemic (pH1N1) 2009 virus. Rates of decreased work performance reported by patients with diarrhea and influenza-like illness were similar (46% versus 48%; P = 0.8). Diarrheal diseases and respiratory illness remain common among deployed military personnel, with important operational impact. Despite an ongoing influenza pandemic, diarrheal disease incidence was higher than that of respiratory illness.

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Section: Discussionmentioning

confidence: 70%

Hotel Clinic-Based Diarrheal and Respiratory Disease Surveillance in U.S. Service Members Participating in Operation Bright Star in Egypt, 2009

Sebeny

Nakhla²,

Moustafa³

et al. 2012

The American Society of Tropical Medicine and Hygiene

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“…Instead, personnel may wait days and only request medical attention if symptoms persist or worsen. 5 Standardized guidance recommending medical treatment for personnel experiencing watery diarrhea or bloody stools at the first onset of symptoms is needed.…”

Section: Discussionmentioning

confidence: 99%

“…5,12,13 In a Cochrane meta-analysis of six randomized, double-blind, placebo-controlled trials several years ago, the efficacy of antibiotic treatment with TD were assessed. Antibiotics examined in the trials included trimethoprim/sulfamethoxazole, bicozamycin, norfloxacin, ciprofloxacin, and fleroxacin.…”

Section: Introductionmentioning

confidence: 99%

Antibiotic Therapy for Acute Watery Diarrhea and Dysentery

Tribble

2017

Military Medicine

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Diarrheal disease affects a large proportion of military personnel deployed to developing countries, resulting in decreased job performance and operational readiness. Travelers’ diarrhea is self-limiting and generally resolves within five days; however, antibiotic treatment significantly reduces symptom severity and duration of illness. Presently, azithromycin is the preferred first-line antibiotic for the treatment of acute watery diarrhea (single dose 500 mg), as well as for febrile diarrhea and dysentery (single dose 1000 mg). Levofloxacin and ciprofloxacin are also options for acute watery diarrhea (single dose 500 mg and 750 mg, respectively) and febrile diarrhea/dysentery in areas with high rates of Shigella (500 mg once for three days [once daily with levofloxacin and twice daily with ciprofloxacin]), but are becoming less effective due to increasing fluoroquinolone resistance, particularly among Campylobacter spp. Another alternate for acute watery diarrhea is rifaximin (200 mg three times per day for three days); however, it should not be used with invasive illness. Use of loperamide in combination with antibiotic treatment is also beneficial as it has been shown to further reduce gastrointestinal symptoms and duration of illness. Due to regional differences in the predominance of pathogens and resistance levels, choice of antibiotic should take travel destination into consideration.

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“…3,4 Predominantly, travelers’ diarrhea is the result of enteric bacterial pathogens, including enterotoxigenic Escherichia coli, enteroaggregative E. coli, Campylobacter jejuni, Shigella spp., and non-typhoidal Salmonella species. 2,5,6 Although it is a self-limiting illness that is often resolved within five days following the onset of symptoms, 1,2,7 enteric bacteria recovered from patients with travelers’ diarrhea have been associated with post-infectious sequelae, such irritable bowel syndrome (IBS). 8,9 …”

mentioning

confidence: 99%

“…6,10–13 In addition, antimotility agents, such as loperamide, may be used to mitigate the symptoms of acute diarrheal episodes. While use of loperamide does not result in clinical cure, 2,14 there is an additive benefit when it is administered in combination with antibiotic therapy.…”

mentioning

confidence: 99%

Preface: Guidelines for the Treatment of Travelers' Diarrhea in Deployed Military Personnel

Riddle

Tribble

2017

Military Medicine

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Diarrheal disease frequently affects military personnel deployed to developing countries, resulting in decreased job performance and potential negative impacts on military operational readiness. Travelers’ diarrhea is a self-limiting illness; however, antibiotic treatment (with and without use of adjunct loperamide therapy) has been shown to significantly reduce clinical presentation of symptoms and duration of illness. Nonetheless, the choice of first-line antibiotics must be carefully considered as increasing resistance of enteric pathogens in endemic regions has rendered many first-line antibiotics ineffective (e.g., Campylobacter spp. are resistant to fluoroquinolones in Southeast Asia). Presently, there are no standardized recommendations for the treatment of travelers’ diarrhea among deployed military personnel. Therefore, an expert panel was convened to develop evidence-based, consensus-driven guidelines that address key clinical issues related to self-treatment, antibiotic treatment for acute watery diarrhea and febrile diarrhea/dysentery, and diagnostics. These guidelines ‘Management of Acute Diarrheal Illness during Deployment’ are published in this supplement along with articles reviewing the evidence-based data that supported their development.

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Clinical Treatment of Nondysentery Travelers’ Diarrhea During Deployment

Cited by 11 publications

References 46 publications

Hotel Clinic-Based Diarrheal and Respiratory Disease Surveillance in U.S. Service Members Participating in Operation Bright Star in Egypt, 2009

Hotel Clinic-Based Diarrheal and Respiratory Disease Surveillance in U.S. Service Members Participating in Operation Bright Star in Egypt, 2009

Antibiotic Therapy for Acute Watery Diarrhea and Dysentery

Preface: Guidelines for the Treatment of Travelers' Diarrhea in Deployed Military Personnel

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