Traveler's diarrhea prevention: Difference between revisions

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Revision as of 16:25, 1 March 2016

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

At this time, prophylactic antibiotics should not be recommended for most travelers. Prophylactic antibiotics using fluoroquinolones may be effective in the prevention of some cases of traveler's diarrhea (e.g. Norfloxacin 400 mg PO qd). A traveler relying on prophylactic antibiotics will need to carry an alternative antibiotic to use in case diarrhea develops despite prophylaxis. Other preventive measures include maintaining good hygiene, drinking safe water, and proper food handling during travel.

Prevention

Antimicrobial Prophylaxis

At this time, prophylactic antibiotics should not be recommended for most travelers.
Prophylactic antibiotics are effective in the prevention of some cases of traveler's diarrhea.
Fluoroquinolones are considered the most effective prophylactic therapy for traveler's diarrhea.
A traveler relying on prophylactic antibiotics will need to carry an alternative antibiotic to use in case diarrhea develops despite prophylaxis.
The use of prophylactic antibiotics should be weighed against the result of using prompt, early self-treatment with antibiotics when TD occurs, which can limit the duration of illness to 6–24 hours in most cases.
Prophylactic antibiotics may be considered for short-term travelers who are high-risk hosts (such as those who are immunosuppressed) or who are taking critical trips (such as engaging in a sporting event) during which even a short bout of diarrhea could affect the trip.

Traveler’s diarrhea

Prophylaxis^[1]

Preferred regimen (2): Norfloxacin 400 mg PO qd
Preferred regimen (3): Ciprofloxacin 500 mg PO qd
Preferred regimen (4): Rifaximin 200 mg PO qd or bid

Non-pharmacologic Prevention

Primary Prevention

Traveler's diarrhea may be prevented through proper water quality management systems as found in responsible hotels and resorts.

Maintain good hygiene and make sure that you drink safe water, even for teeth brushing.
Use only safe bottled water. Reports of locals filling bottles with tap water, then sealing them and then selling the bottled water as purified water have come out of several countries.

Drink safe beverages include bottled carbonated beverages, hot tea or coffee, beer, wine, and water boiled or appropriately treated by yourself.

Active intervention involves boiling water for three to five minutes (depending on elevation), filtering water with appropriate filters or using chlorine bleach (2 drops per litre) or tincture of iodine (5 drops per litre) in the water. The wide availability of safe bottled water makes these interventions usually unnecessary for all but the most remote destinations.
Avoid eating raw fruits and vegetables unless the traveler peels them.
If handled properly, well-cooked and packaged foods are usually safe. Avoid eating raw or undercooked meat and seafood. Unpasteurized milk, dairy products, mayonnaise and pastry icing are associated with increased risk for TD, as are foods or drinking beverages purchased from street vendors or other establishments where unhygienic conditions are present.

References

↑ "The Practice of Travel Medicine: Guidelines by the Infectious Diseases Society of America" (PDF).

Template:WikiDoc Sources

[1] "The Practice of Travel Medicine: Guidelines by the Infectious Diseases Society of America" (PDF).

[1]

@@ Line 3: / Line 3: @@
 {{CMG}}
 ==Overview==
-Primary measures to prevent [[gastrointestinal]] illness are keeping good [[hygiene]], getting specific [[vaccines]] and [[prophylactic]] medications. It is not recommend to take [[antimicrobial drug]]s to prevent traveler's diarrhea.
+At this time, prophylactic antibiotics should not be recommended for most travelers. Prophylactic antibiotics using [[fluoroquinolones]] may be effective in the prevention of some cases of traveler's diarrhea (e.g. [[Norfloxacin]] 400 mg PO qd). A traveler relying on prophylactic antibiotics will need to carry an alternative antibiotic to use in case diarrhea develops despite prophylaxis. Other preventive measures include maintaining good hygiene, drinking safe water, and proper food handling during travel.
-==Primary Prevention==
+==Prevention==
-*Traveler's diarrhea is fundamentally a sanitation failure, leading to bacterial contamination of [[drinking water]] and food. It is best prevented through proper water quality management systems as found in responsible hotels and resorts. In the absence of that, the next best option for the educated traveler is to take precautions to prevent the disease.
+===Antimicrobial Prophylaxis===
-** Maintain good hygiene and make sure that you drink [[safe water]], even for teeth brushing.
+*At this time, prophylactic antibiotics should not be recommended for most travelers.
-** Use only safe [[bottled water]]. Reports of locals filling bottles with [[tap water]], then sealing them and then selling the bottled water as purified water have come out of several countries.
+*Prophylactic antibiotics are effective in the prevention of some cases of traveler's diarrhea.
-**Drink safe beverages include bottled carbonated beverages, hot tea or coffee, beer, wine, and water boiled or appropriately treated by yourself.
+*[[Fluoroquinolones]] are considered the most effective prophylactic therapy for traveler's diarrhea.
-** Active intervention involves boiling water for three to five minutes (depending on elevation), filtering water with appropriate filters or using chlorine bleach (2 drops per [[litre]]) or tincture of [[iodine]] (5 drops per litre) in the water. The wide availability of safe bottled water makes these interventions usually unnecessary for all but the most remote destinations.
+*A traveler relying on prophylactic antibiotics will need to carry an alternative antibiotic to use in case diarrhea develops despite prophylaxis.
-** Avoid eating raw fruits and vegetables unless the traveler peels them.
+*The use of prophylactic antibiotics should be weighed against the result of using prompt, early self-treatment with antibiotics when TD occurs, which can limit the duration of illness to 6–24 hours in most cases.
-** If handled properly, well-cooked and packaged foods are usually safe. Avoid eating raw or undercooked meat and seafood. Unpasteurized milk, dairy products, mayonnaise and pastry icing are associated with increased risk for TD, as are foods or drinking beverages purchased from street vendors or other establishments where unhygienic conditions are present.
+*Prophylactic antibiotics may be considered for short-term travelers who are high-risk hosts (such as those who are immunosuppressed) or who are taking critical trips (such as engaging in a sporting event) during which even a short bout of diarrhea could affect the trip.
-*It is not recommend to take antimicrobial drugs to prevent TD, because they kill off beneficial bacteria and create resistant breeds of pathogenic (disease-causing) bacteria. Studies show a decrease in the incidence of TD with use of [[bismuth subsalicylate]] and with use of antimicrobial chemoprophylaxis.
+:* '''Traveler’s diarrhea'''
+::* '''Prophylaxis'''<ref>{{Cite web | title = The Practice of Travel Medicine: Guidelines by the Infectious Diseases Society of America   | url = http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/Travel%20Medicine.pdf }} </ref>
+:::* Preferred regimen (2): [[Norfloxacin]] 400 mg PO qd
+:::* Preferred regimen (3): [[Ciprofloxacin]] 500 mg PO qd
+:::* Preferred regimen (4): [[Rifaximin]] 200 mg  PO qd or bid
-*Several [[probiotics]] ([[Saccharomyces boulardii]] and a mixture of [[Lactobacillus acidophilus]] and Bifidobacterium bifidum) have significant efficacy. In a meta-analysis by McFarland (2005), no serious adverse reactions were reported in the 12 trials. [[Probiotics]] may offer a safe and effective method to prevent TD.<ref>{{cite journal
+===Non-pharmacologic Prevention===
-  | last = McFarland
+==Primary Prevention==
-  | first = Lynn
+*Traveler's diarrhea may be prevented through proper water quality management systems as found in responsible hotels and resorts.
-  | title = Meta-analysis of probiotics for the prevention of traveller’s diarrhoea
+:*Maintain good hygiene and make sure that you drink [[safe water]], even for teeth brushing.
-  | journal = Travel Medicine and Infectious Disease
+:*Use only safe [[bottled water]]. Reports of locals filling bottles with [[tap water]], then sealing them and then selling the bottled water as purified water have come out of several countries.
-  | volume = 5
+*Drink safe beverages include bottled carbonated beverages, hot tea or coffee, beer, wine, and water boiled or appropriately treated by yourself.
-  | issue = 2
+:*Active intervention involves boiling water for three to five minutes (depending on elevation), filtering water with appropriate filters or using chlorine bleach (2 drops per [[litre]]) or tincture of [[iodine]] (5 drops per litre) in the water. The wide availability of safe bottled water makes these interventions usually unnecessary for all but the most remote destinations.
-  | pages = 97-105
+:*Avoid eating raw fruits and vegetables unless the traveler peels them.
-  | url =http://www.dtecta.co.uk/casestudies/McFarland_L._V._(2005)_Meta_analysis_of_probiotics_for_the_prevention_of_travellers_diarrhoea_Travla_DTECTA_Probiotics_www.dtecta.co.uk.pdf?cmd=Retrieve&db=PubMed&list_uids=8682428&dopt=Abstract}}</ref>
+:*If handled properly, well-cooked and packaged foods are usually safe. Avoid eating raw or undercooked meat and seafood. Unpasteurized milk, dairy products, mayonnaise and pastry icing are associated with increased risk for TD, as are foods or drinking beverages purchased from street vendors or other establishments where unhygienic conditions are present.
 == References ==