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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.

Authors+Show Affiliations

Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada.Department of Family Medicine, The University of Alberta, Edmonton, Alberta, Canada.Department of Family Medicine, The University of Calgary, Calgary, Alberta, Canada.Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31084597

Citation

Leung, Alexander K C., et al. "Travelers' Diarrhea: a Clinical Review." Recent Patents On Inflammation & Allergy Drug Discovery, vol. 13, no. 1, 2019, pp. 38-48.
Leung AKC, Leung AAM, Wong AHC, et al. Travelers' Diarrhea: A Clinical Review. Recent Pat Inflamm Allergy Drug Discov. 2019;13(1):38-48.
Leung, A. K. C., Leung, A. A. M., Wong, A. H. C., & Hon, K. L. (2019). Travelers' Diarrhea: A Clinical Review. Recent Patents On Inflammation & Allergy Drug Discovery, 13(1), 38-48. https://doi.org/10.2174/1872213X13666190514105054
Leung AKC, et al. Travelers' Diarrhea: a Clinical Review. Recent Pat Inflamm Allergy Drug Discov. 2019;13(1):38-48. PubMed PMID: 31084597.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Travelers' Diarrhea: A Clinical Review. AU - Leung,Alexander K C, AU - Leung,Amy A M, AU - Wong,Alex H C, AU - Hon,Kam L, PY - 2018/11/22/received PY - 2019/04/30/revised PY - 2019/05/10/accepted PY - 2019/5/16/pubmed PY - 2020/1/16/medline PY - 2019/5/16/entrez KW - Antibiotic KW - Escherichia coli KW - antimotility agent KW - contaminated food KW - oral rehydration KW - vaccination. SP - 38 EP - 48 JF - Recent patents on inflammation & allergy drug discovery JO - Recent Pat Inflamm Allergy Drug Discov VL - 13 IS - 1 N2 - 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. SN - 1872-213X UR - https://www.unboundmedicine.com/medline/citation/31084597/Travelers'_Diarrhea:_A_Clinical_Review_ L2 - http://www.eurekaselect.com/172118/article DB - PRIME DP - Unbound Medicine ER -