Travelers’ Diarrhea: A Clinical Review

Abstract

Background: Travelers’ diarrhea is the most common travel-related malady. It affects millions of international travelers to developing countries annually and can significantly disrupt travel plans. Objective: To provide an update on the evaluation, diagnosis, treatment, and prevention of traveler’s diarrhea. Methods: A PubMed search was completed in Clinical Queries using the key term “traveler’s diarrhea”. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to English literature. Patents were searched using the key term “traveler’s diarrhea” from www.freepatentsonline.com. Results: Between 10% and 40% of travelers develop diarrhea. The attack rate is highest for travelers from a developed country who visit a developing country. Children are at particular risk. Travelers’ diarrhea is usually acquired through ingestion of food and water contaminated by feces. Most cases are due to a bacterial pathogen, commonly, Escherichia coli, and occur within the first few days after arrival in a foreign country. Dehydration is the most common complication. Pretravel education on hygiene and on the safe selection of food items is important in minimizing episodes. For mild travelers’ diarrhea, the use of antibiotic is not recommended. The use of bismuth subsalicylate or loperamide may be considered. For moderate travelers’ diarrhea, antibiotics such as fluoroquinolones, azithromycin, and rifaximin may be used. Loperamide may be considered as monotherapy or adjunctive therapy. For severe travelers’ diarrhea, antibiotics such as azithromycin, fluoroquinolones, and rifaximin should be used. Azithromycin can be used even for the treatment of dysentery whereas fluoroquinolones and rifaximin cannot be used for such purpose. Recent patents related to the management of travelers’ diarrhea are discussed. Conclusion: Although travelers’ diarrhea is usually self-limited, many travelers prefer expedient relief of diarrhea, especially when they are traveling for extended periods by air or ground. Judicious use of an antimotility agent and antimicrobial therapy reduces the duration and severity of diarrhea.

Infectious disease symptoms and microbial carriage among French medical students travelling abroad: A prospective study

“…Such high rates of EPEC in both asymptomatic medical students and an older Muslim population from Marseille at baseline warrants further investigation in different populations, to better understand the local epidemiology of EPEC in southern France. Nevertheless, we documented a dramatically high acquisition rate of EAEC (53.0%) and EPEC (41.0%) among medical students, as documented in other recent studies conducted in different populations of international travellers [25][26][27][28][29][30][31]. This acquisition of E. coli is worrying and deserves further investigation aimed at evaluating antibiotic resistance in these bacteria, since one study conducted in medical students revealed a 35% acquisition rate of extended-spectrum beta-lactamase-producing Enterobacteriae [8].…”

Probiotics: Versatile Bioactive Components in Promoting Human Health

“…The effectiveness of probiotics has also been proven in the case of traveler’s diarrhea. Thus, in a meta-analysis of 12 clinical trials and 5171 patients, a 15% reduction in the risk of developing traveler’s diarrhea was observed in the case of prevention by probiotic administration starting two days before the trip and continuing during the trip [ 29 ].…”

Animal Models of Phage Therapy

“…Many studies have focused on E. coli , one of the most common causes of diarrheal illness in humans throughout the world ( Leung et al, 2019 ). As mentioned earlier, Smith and Huggins (1983) looked at treatment of E. coli diarrhea in calves, pigs, and lambs.…”