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    International Journal of Nursing and Health Research: Management of Traveler's Diarrhea: Short Review

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    Ari Putra
    This document provides a short review of the management of traveler's diarrhea. It discusses the causes, classification, diagnosis, treatment and prevention of traveler's diarrhea. The main points are: - Traveler's diarrhea is typically caused by contaminated food/water and bacteria like E. coli. - Management involves self-diagnosis, hydration, medication for symptom relief, and antibiotics in moderate-severe cases. Resolution usually occurs within 3-5 days without antibiotics. - Prevention strategies include selecting safe food/beverages. Prophylactic antibiotics are not recommended for most travelers but may be used in some high-risk groups.

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    International Journal of Nursing and Health Research: Management of Traveler's Diarrhea: Short Review

    Uploaded by

    Ari Putra
    55 views2 pages
    This document provides a short review of the management of traveler's diarrhea. It discusses the causes, classification, diagnosis, treatment and prevention of traveler's diarrhea. The main points are: - Traveler's diarrhea is typically caused by contaminated food/water and bacteria like E. coli. - Management involves self-diagnosis, hydration, medication for symptom relief, and antibiotics in moderate-severe cases. Resolution usually occurs within 3-5 days without antibiotics. - Prevention strategies include selecting safe food/beverages. Prophylactic antibiotics are not recommended for most travelers but may be used in some high-risk groups.

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    This document provides a short review of the management of traveler's diarrhea. It discusses the causes, classification, diagnosis, treatment and prevention of traveler's diarrhea. The main points are: - Traveler's diarrhea is typically caused by contaminated food/water and bacteria like E. coli. - Management involves self-diagnosis, hydration, medication for symptom relief, and antibiotics in moderate-severe cases. Resolution usually occurs within 3-5 days without antibiotics. - Prevention strategies include selecting safe food/beverages. Prophylactic antibiotics are not recommended for most travelers but may be used in some high-risk groups.

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    © All Rights Reserved
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    Download as pdf or txt
    55 views2 pages

    International Journal of Nursing and Health Research: Management of Traveler's Diarrhea: Short Review

    Uploaded by

    Ari Putra
    This document provides a short review of the management of traveler's diarrhea. It discusses the causes, classification, diagnosis, treatment and prevention of traveler's diarrhea. The main points are: - Traveler's diarrhea is typically caused by contaminated food/water and bacteria like E. coli. - Management involves self-diagnosis, hydration, medication for symptom relief, and antibiotics in moderate-severe cases. Resolution usually occurs within 3-5 days without antibiotics. - Prevention strategies include selecting safe food/beverages. Prophylactic antibiotics are not recommended for most travelers but may be used in some high-risk groups.

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    © All Rights Reserved
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    of 2

    International Journal of Nursing and Health Research

    International Journal of Nursing and Health Research


    www.nursingjournal.in
    Online ISSN: 2664-6420, Print ISSN: 2664-6412
    Received Date: 01-11-2018 Accepted Date: 03-12-2018; Published: 03-01-2019
    Volume 1; Issue 1; 2019; Page No. 01-02

    Management of traveler’s Diarrhea: Short review


    Dr. Zahid Nabi Qureshi1*, Dr. Dileep Kumar2, Dr. Muhammad Ismail3, Dr. Muhammad Ejaz4
    Specialist Family Medicine, Dubai health Authority-UAE, United Arab Emirates

    Abstract
    It is typically caused by the consumption of contaminated food or water, predominantly by bacteria. Prevention strategies include careful
    selection of food and beverages. Prophylactic antibiotics are not recommended for most travelers. Management is self-diagnosis while
    still travelling, followed by hydration, medicine for symptom relief, and antibiotics therapy which is generally reserved for moderate to
    severe infections. In healthy patients, resolution is typically within 3 to 5 days even without antibiotic treatment.

    Keywords: consumption, management, moderate

    Introduction
    Traveler’s diarrhea (TD) is defined as ≥3 unformed stools in 24 ships), and other enteric viral infections.
    hours accompanied by at least 1 of the following: fever, nausea, c. Parasitic traveler’s diarrhea: more persistent (>14 days)
    vomiting, cramps, tenesmus, or bloody stools (dysentery) during diarrhea due to parasitic infection with Giardia, Entamoeba,
    a trip abroad, typically to a low- or middle-income country. It is or Cryptosporidium.
    usually a benign self-limited illness lasting 3 to 5 days [1].
    Risk factors include age <30 years, suppressed stomach acidity However, self-limited post-infectious irritable bowel syndrome is
    (due to use of proton-pump inhibitors, H2 blockers), immune an even more frequent finding in returning travelers with
    suppression, lack of previous travel to high-risk destinations in persisting diarrhea [4].
    the past 6 months, hot and wet climate [2].
    Prevention
    Classification Careful selection of safe food and beverages. Prophylactic
    1. Clinical antibiotics are not recommended for most travelers [1, 5] except
    a. Tolerable (Mild): Diarrhea is not distressing, and does not short-term critical itineraries such as diplomatic missions,
    interfere with planned activities. professional sports, and critical business/life event engagements
    b. Distressing (Moderate): Diarrhea that interferes with and chronically ill or immunocompromised patients on trips of
    planned activities. <3 weeks' duration. Rifaximin is considered the treatment of
    c. Incapacitating (Severe): Diarrhea that is completely prevents choice for prophylaxis. [6-8] Fluoroquinolones are not
    planned activities. Dysentery (passage of grossly bloody recommended for the prophylaxis of TD [1]. Antibiotic
    stools) is considered severe. prophylaxis is not usually recommended in children.
    d. Persistent: diarrhea lasting ≥2 weeks.
    Diagnosis
    2. Etiological Clinical, stool examination (culture and sensitivity) if severe or
    a. Bacterial traveler’s diarrhea (80—90%): common infection persistent diarrhea. PCR can be done to detect multiple
    usually due to enterotoxigenic Escherichia coli (ETEC) and pathogens. Stool for ova and parasite, protozoal stool antigen test
    enter aggregative E coli, Shigella, Salmonella (non-typhoid), if persistent diarrhea. Clostridium difficile stool toxin if suspect
    Campylobacter jejuni, Yersinia, Aeromonas hydrophila, antibiotic induced diarrhea.
    Plesiomonas shigelloides, and Vibrio (non-cholera) species [3]. In chronic diarrhea need CBC, CRP, ESR, celiac disease
    b. Viral traveler’s diarrhea: diarrhea due to rotavirus antigens, colonoscopy, endoscopy and biopsy to rule out IBD,
    (especially in infants and children), norovirus (e.g., on cruise cancers, malabsorption syndrome.

    1
    International Journal of Nursing and Health Research

    Table 1
    Differential Diagnosis Features Workup
    Food poisoning Vomiting followed by diarrhea within hours Clinical, stool culture
    IBS Diarrhea alternate constipation, no weight change Normal examination and laboratory test
    IBD Diarrhea with fever, abdominal pain CBC, ESR, colonoscopy
    Celiac D Foul smelling chronic diarrhea, dermatitis herpetiformis Serology test (AGA, AGG, tTGA, EMA)
    pseudomembranous colitis Drug induced C difficile Stool toxin test

    Treatment stool for ova/parasite and give metronidazole or


    1. Rehydration (ORS) tinidazole.
    2. Adjunct Therapy (symptoms relief):
    a. Loperamide (antimotality agent): Alone or with Emerging treatment
    antibiotics. Avoid in pregnancy, child <6 years and 1. Rifamycin. FDA approved for watery diarrhea
    dysentery 2. Crofelemer. For watery diarrhea (acute, HIV, IBS,
    b. Bismuth subsalicylate: mild infections. Avoid in pediatric), reduce stool volume in 6 hours
    pregnancy, child <12 years (Reye’s syndrome risk) 3. Prebiotics & probiotics
    c. Antibiotics (1st line: Azithromycin, 2nd line: Rifaximin, 4. Cholera vaccine
    quinolones) 5. Diosmectite. Ion anti-secretory agent and to prevent
    d. Anti-parasitic agents: if no response with antibiotic, test intestinal damage.

    Table 2
    Prophylaxis Started before departure and discontinued after travel
    Rifaximin 200-1100 mg/day orally given in 1-3 divided doses
    Bismuth subsalicylate 524-1048 mg orally four times daily
    Treatment
    Loperamide 4 mg initial  2 mg / each unformed stool, maximum 16 mg/day
    Azithromycin 1000 mg orally single dose or 500 mg orally once daily for 3 days
    Rifaximin 200 mg orally three times daily for 3 days
    Ciprofloxacin 750 mg single dose or 500 mg once daily for 3 days
    Ofloxacin 400 mg orally once daily for 1-3 days
    Levofloxacin 500 mg orally once daily for 1-3 days
    Children
    Azithromycin 10 mg/kg orally once daily for 1-3 days, maximum 500 mg/day
    Rifaximin 200 mg orally three times daily for 3 days
    Ciprofloxacin 20-30 mg/kg/day orally given in 1-2 divided doses for 1-3 days

    Complications randomized, double-blind, placebo-controlled trials. J Travel


    1. Post TD lactose intolerance Med. 2012; 19(6):352-6.
    2. Post TD IBS 7. Alajbegovic S, Sanders JW, Atherly DE, et al. Effectiveness
    3. Antibiotic side effect (pseudomembranous colitis) of Rifaximin and Fluoroquinolones in preventing travelers'
    4. Hemolytic Uremic Syndrome diarrhea (TD): a systematic review and meta-analysis. Syst
    Rev. 2012; 28(1)39.
    References 8. Martinez-Sandoval F, Ericsson CD, Jiang ZD, et al.
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    traveler's diarrhea. N Engl J Med. 1993; 328(25):1821-7. the prevention and treatment of travelers' diarrhea: a graded
    3. Laaveri T, Vilkman K, Pakkanen SH, et al. A prospective expert panel report. J Travel Med. 2017 24(suppl 1):S57-74.
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