Travellers' diarrhoea

Risk of travellers' diarrhoea is about 7% in developed countries and 20–50% in the developing world. Options for prevention include education and chemoprophylaxis. Vaccination is a promising but incomplete option. Achieving behaviour modification of food and water choices among tourists is diff...

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Bibliographic Details
Published in:International journal of antimicrobial agents 2003-02, Vol.21 (2), p.116-124
Main Author: Ericsson, Charles D
Format: Article
Language:English
Subjects:
Adult
Algorithms
Anti-Infective Agents - therapeutic use
Antibacterial agents
Antibiotics. Antiinfectious agents. Antiparasitic agents
Azithromycin
Aztreonam
Biological and medical sciences
Diarrhea - etiology
Diarrhea - prevention & control
Diarrhea - therapy
Digestive system
Epidemiologic Factors
Food Microbiology
Food Parasitology
Humans
Medical sciences
Pharmacology. Drug treatments
Prophylaxis
Rifaximin
Risk Factors
Travel
Travellers’ diarrhoea
Water - parasitology
Water Microbiology
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Summary:Risk of travellers' diarrhoea is about 7% in developed countries and 20–50% in the developing world. Options for prevention include education and chemoprophylaxis. Vaccination is a promising but incomplete option. Achieving behaviour modification of food and water choices among tourists is difficult. Bismuth subsalicylate (BSS)-containing compounds are about 62% effective in the prevention of travellers' diarrhoea. Antibiotics are about 84% effective in preventing travellers' diarrhoea. Routine prophylaxis of travellers' diarrhoea, especially with antibiotics, should be discouraged. Oral rehydration is generally important in the treatment of diarrhoea, but travellers' diarrhoea is only infrequently dehydrating in adults. The addition of oral rehydration solutions confers no additional benefit to loperamide in the treatment of travellers' diarrhoea in adults. Presently, the most active of the antibiotics routinely available for treatment are members of the fluoroquinolone group. Antibiotics that are not absorbed such as aztreonam and a rifampicin-like agent, rifaximin, are both effective. The latter might become a therapy of choice once it is routinely available, due to predictably less adverse reactions with a non-absorbed antibiotic. Preliminary results with azithromycin look very promising. Less severe disease can be treated with a variety of non-antibiotic agents (e.g. BSS-containing compounds, loperamide and a calmodulin inhibitor, zaldaride). The combination of an antibiotic and loperamide is superior to treatment with either agent alone in a several studies and is arguably the treatment of choice for distressing travellers' diarrhoea.
ISSN:0924-8579
1872-7913
DOI:10.1016/S0924-8579(02)00282-0