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Traveler’s Diarrhea, Bibliography Steffen, R., Hill, D., & DuPont, H.…

- - - - high risk
    - - Intermediate risk
    - - Low risk
  - - - the highest risk
  - - - high risk
  - - - Low risk
    - - high risk
  - - - eat more food
        
        ingestion of a larger inoculum of pathogens
- - - - tenesmus
      - nausea
      - vomiting
      - fever
      - abdominal cramps
      - fecal urgency
- - - - 1-3 loose stools per 24 hours with or without mild enteric symptoms and activities not affected
    - - bismuth subsalicylate
      - loperamide
        
        should not be given to children
        younger than 2 years
        
        should not be used as a single medication without antibiotics in patient who
        
        Temperature greater than 38.5°C
        
        bloody stools are passed
    - - promethazine
        
        in children
      - ondansetron
      - promethazine
        
        in adolescents and adults
    - - fluoroquinolone
        
        For most destinations
      - azithromycin
        
        where Campylobacter species are a common etiology
        
        South and Southeast Asia
      - Rifaximin
        
        not be used when there are signs of invasive illness
      - can reduce the duration of travelers' diarrhea from several days to one or two days.
- - - - most food items served piping hot at 60°C are safe
  - - - Bismuth subsalicylate
        
        provides modest protection against traveler’s diarrhea
        
        Reduces the traveler’s diarrhea rate by 65% when given 4 times daily while traveling
        
        Adverse effects
        
        tongue and stools black
        
        should be avoided in patients taking anticoagulants or long-term salicylate therapy
      - Rifaximin
        
        reduced the incidence of noninvasive traveler’s diarrhea 48%
        
        Considered safe as it is not absorbed
      - Systemic antibiotics taken prophylactically
        
        Can reduce the incidence of traveler’s diarrhea by more than 90%.
        
        fluoroquinolones typically are most often considered
        
        recommended only for a few travelers
        
        persons who must avoid dehydration
        
        persons with ileostomies or colostomies
        
        travelers on short trips who have important duties precluding time off for an illness
        
        not more than 2 to 3 weeks
        
        Adverse effects
        
        development of resistance