Stand-by antibiotics encourage unwarranted use of antibiotics for travelers’ diarrhea: A prospective study

Vilkman, Katri; Lääveri, Tinja; Pakkanen, Sari H.; Kantele, Anu

doi:10.1016/j.tmaid.2018.06.007

Cited by 23 publications

(19 citation statements)

References 27 publications

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“…Older travelers used antibiotics for loose stools (54.2%), mild TD (62.1%), and ILI (63.0%), contrary to published guidelines that discourage the use of antibiotics when a bacterial infection is unlikely. Overuse of standby antibiotic has been previously described: in a study by Vilkman et al, travelers carrying antibiotics used them at significantly higher rates for milder and moderate TD than noncarriers (38.0% vs 4.0%) [ 18 ]. Perhaps travelers, out of an abundance of caution, preemptively take antibiotics with mild symptoms for precautionary measures, and unknowingly are increasing their risk of antibiotic-related harm [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Travel-Related Risk Behaviors and Antibiotic Use Among Older Travelers

Costello

Tribble

Eickhoff

et al. 2021

Open Forum Infectious Diseases

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Background Antibiotic stewardship in the pre-travel care of older adults is important to effectively treat infections while minimizing harm from side effects and unnecessary antibiotic use. The objective of this study was to compare the characteristics, risk behaviors, infectious diseases and antibiotic use between older (≥ 60 years) and younger (18-59 years) travelers. Methods TravMil is a prospective, observational cohort of United States Department of Defense beneficiaries traveling outside the continental US for ≤ 6.5 months. For this analysis, we included adults enrolled pre-travel between January 2010–August 2018 and excluded active duty personnel on deployment. Pre- and post-travel surveys captured trip characteristics, exposures, illnesses, and antibiotic use. Results 1742 travelers were analyzed: 747 (42.9%) were ≥ 60 years and 995 (57.1%) were 18-59 years. Older travelers were less likely to engage in high-risk dietary behaviors and experience travelers’ diarrhea than younger travelers (18.2% vs 22.9%; p<0.05). Influenza-like illnesses (12.5%) and febrile illness (3.4%) occurred less frequently in the older cohort. Antibiotic use for self treatment was common in both age groups (25.7% vs. 26.7%) and often inappropriate e.g. for treatment of occasional loose stool or mild travelers’ diarrhea (older adults 67.0% [67/100] vs. younger adults 57.6% [83/144]; p <0.05), and influenza-like illnesses (63.4% [64/101] vs. 58.6% [68/116]; p<0.05). Conclusions Older travelers were less likely to engage in high-risk behaviors and experience travelers’ diarrhea, and both age groups experienced mild, self-limited infections. Inappropriate use of antibiotics was common, suggesting that antimicrobial stewardship should be emphasized at pre-travel counseling with international travelers.

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Section: Discussionmentioning

confidence: 99%

Travel-Related Risk Behaviors and Antibiotic Use Among Older Travelers

Costello

Tribble

Eickhoff

et al. 2021

Open Forum Infectious Diseases

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“…International travelers are at increased risk of acquiring QNS enteric bacterial infections and importing them into the United States, which can lead to onward transmission and domestic outbreaks of infections that are difficult to treat [4, 16]. Empiric antimicrobial treatment of travelers’ diarrhea is rarely required, is more common when travelers carry antibiotics with them [21], and may exacerbate the problem of acquisition and importation of antibiotic-resistant infections [3, 22, 23]. Fluroquinolones can also precipitate serious adverse events, such as rupture of the Achilles tendon, fatal dysrhythmias, and C .…”

Section: Discussionmentioning

confidence: 99%

Quinolone nonsusceptibility among enteric pathogens isolated from international travelers – Foodborne Diseases Active Surveillance Network (FoodNet) and National Antimicrobial Monitoring System (NARMS), 10 United States sites, 2004 – 2014

et al. 2019

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Gastrointestinal illnesses are the most frequently diagnosed conditions among returning U.S. travelers. Although most episodes of travelers’ diarrhea do not require antibiotic therapy, fluoroquinolones (a type of quinolone antibiotic) are recommended for treatment of moderate and severe travelers’ diarrhea as well as many other types of severe infection. To assess associations between quinolone susceptibility and international travel, we linked data about isolate susceptibility in NARMS to cases of enteric infections reported to FoodNet. We categorized isolates as quinolone-nonsusceptible (QNS) if they were resistant or had intermediate susceptibility to ≥1 quinolone. Among 1,726 travel-associated infections reported to FoodNet with antimicrobial susceptibility data in NARMS during 2004–2014, 56% of isolates were quinolone-nonsusceptible, of which most (904/960) were Campylobacter. International travel was associated with >10-fold increased odds of infection with quinolone-nonsusceptible bacteria. Most QNS infections were associated with travel to Latin America and the Caribbean (390/743; 52%); however, the greatest risk of QNS infection was associated with travel to Africa (120 per 1,000,000 passenger journeys). Preventing acquisition and onward transmission of antimicrobial-resistant enteric infections among travelers is critical.

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“…Clinicians providing pretravel health consultation should also consider antimicrobial stewardship principles and be cautious about the prescription of broad-spectrum antimicrobials for empiric use by travelers. Recent analyses have shown that although the occurrence of travelers’ diarrhea cannot be controlled for, reducing the use of empiric antimicrobial treatment for travelers’ diarrhea may be useful for lowering the acquisition of travel-associated AMR bacteria [ 21 ▪ , 55 ▪▪ , 82 ].…”

Section: Areas In Need Of Further Investigationmentioning

confidence: 99%

Antimicrobial-resistant bacteria in international travelers

Sridhar

Turbett

Harris

et al. 2021

Current Opinion in Infectious Diseases

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Purpose of review Antimicrobial resistance (AMR) in bacteria poses a major risk to global public health, with many factors contributing to the observed increase in AMR. International travel is one recognized contributor. The purpose of this review is to summarize current knowledge regarding the acquisition, carriage and spread of AMR bacteria by international travelers. Recent findings Recent studies have highlighted that travel is an important risk factor for the acquisition of AMR bacteria, with approximately 30% of studied travelers returning with an acquired AMR bacterium. Epidemiological studies have shown there are three major risk factors for acquisition: travel destination, antimicrobial usage and travelers’ diarrhea (TD). Analyses have begun to illustrate the AMR genes that are acquired and spread by travelers, risk factors for acquisition and carriage of AMR bacteria, and local transmission of imported AMR organisms. Summary International travel is a contributor to the acquisition and dissemination of AMR organisms globally. Efforts to reduce the burden of AMR organisms should include a focus on international travelers. Routine genomic surveillance would further elucidate the role of international travel in the global spread of AMR bacteria.

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Stand-by antibiotics encourage unwarranted use of antibiotics for travelers’ diarrhea: A prospective study

Abstract: Carriage of stand-by antibiotics encouraged less cautious use of antibiotics. Recommendations involving prescription of antibiotics for all travelers require urgent revision.

Cited by 23 publications

References 27 publications

Travel-Related Risk Behaviors and Antibiotic Use Among Older Travelers

Travel-Related Risk Behaviors and Antibiotic Use Among Older Travelers

Quinolone nonsusceptibility among enteric pathogens isolated from international travelers – Foodborne Diseases Active Surveillance Network (FoodNet) and National Antimicrobial Monitoring System (NARMS), 10 United States sites, 2004 – 2014

Antimicrobial-resistant bacteria in international travelers

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