Skip to main content
SpringerLink
Log in

Management of Travellers’ Diarrhoea

  • Disease Management
  • Published:
Drugs Aims and scope Submit manuscript

Abstract

The most common health problem encountered in international travellers to tropical and subtropical areas is diarrhoea. Even though it is not a life-threatening condition, it may influence deeply the quality of a vacation or the success of a business trip. The majority of cases of travellers’ diarrhoea are due to bacterial pathogens, but viruses and parasites have also been implicated in a minority of patients.

It is advocated that travellers with diarrhoea provide themselves with sources of salt (crackers or soup) and mineral water, to prevent and treat dehydration. Otherwise, treatment recommendations follow illness severity. For mild cases, symptomatic relief alone can be recommended. Loperamide is an effective agent improving diarrhoea and associated symptoms. For moderate diarrhoea (requiring a forced change in itinerary) combination therapy is advised using a fluoroquinolone together with loperamide. Severe diarrhoea [fever >38°C, dysentery (bloody stools) or incapacitating symptoms] should prompt the voyager to take an antibiotic alone for 3 to 5 days. Loperamide is relatively contraindicated in these cases.

For the minority of patients receiving chemoprophylaxis to prevent travellers’ diarrhoea, fluoroquinolones taken once a day while in the area at risk produce the highest protection rate (up to 95%). However, most authorities do not recommend routine prophylaxis for travellers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Handszuh H, Waters SR. Travel and tourism patterns. In: DuPont HL, Steffen R, editors. Textbook of travel medicine and health. Hamilton (Ont): BC Decker Inc., 1997

    Google Scholar 

  2. Gorbach SL, Edelman R. Travelers diarrhea: National Institutes of Health Consensus Conference. JAMA 1985; 253: 2700–4

    Article  Google Scholar 

  3. Ericsson CD, DuPont HL. Travelers diarrhea: approaches to prevention and treatment. Clin Infect Dis 1993 May; 16: 616–24

    Article  PubMed  CAS  Google Scholar 

  4. Merson MH, Morris GK, Sack DA, et al. Travelers diarrhea in Mexico. N Engl J Med 1976 Jun 10; 294(24): 1299–305

    Article  PubMed  CAS  Google Scholar 

  5. BeechamIII HJ, Lebron CI, Echeverria P. Short report: impact of traveler’s diarrhea on United States troops deployed to Thailand. Am J Trop Med Hyg 1997; 57: 699–701

    PubMed  Google Scholar 

  6. Black RE. Epidemiology of travelers diarrhea and relative importance of various pathogens. Rev Infect Dis 1990 Jan–Feb; 12 (1 Suppl.): 73S–9S

    Article  Google Scholar 

  7. Echeverria P, Blacklow NR, Sanford LB, et al. Travelers diarrhea among American peace corps volunteers in rural Thailand. J Infect Dis 1981 Jun; 143(6): 767–71

    Article  PubMed  CAS  Google Scholar 

  8. Taylor DN, Houston R, Shlim DR, et al. Etiology of diarrhea among travelers and foreign residents in Nepal. JAMA 1988 Sep 2; 260(9): 1245–8

    Article  PubMed  CAS  Google Scholar 

  9. Taylor DN, Blaser MJ, Blacklow N, et al. Polymicrobial aetiology of travellers diarrhoea. Lancet 1985 Feb 16; 1: 381–3

    Article  PubMed  CAS  Google Scholar 

  10. Ericsson CD, DuPont HL, Mathewson JJ, et al. Treatment of travelers diarrhea with sulfamethoxazole and trimethoprim and loperamide. JAMA 1990 Jan 12; 263(2): 257–61

    Article  PubMed  CAS  Google Scholar 

  11. Ericsson CD, Nicholls-Vasquez I, DuPont HL, et al. Optimal dosing of trimethoprim-sulfamethoxazole when used with loperamide to treat travelers diarrhea. Antimicrob Agents Chemother 1992 Dec; 36(12): 2821–4

    Article  PubMed  CAS  Google Scholar 

  12. DuPont HL, Ericsson CD, Mathewson JJ, et al. Oral aztreonam, a poorly absorbed yet effective therapy for bacterial diarrhea in US travelers to Mexico. JAMA 1992 Apr 8; 267(14): 1932–5

    Article  PubMed  CAS  Google Scholar 

  13. Bourgeois AL, Gardiner CH, Thornton SA, et al. Etiology of acute diarrhea among United States military personnel deployed to South America and West Africa. Am J Trop Med Hyg 1993; 48(2): 243–8

    PubMed  CAS  Google Scholar 

  14. Ericsson CD, DuPont HL, Mathewson JJ. Single dose ofloxacin plus loperamide compared with single dose or three days of ofloxacin in the treatment of travelers diarrhea. J Travel Med 1997; 4: 3–7

    Article  PubMed  Google Scholar 

  15. Adkins H, Merrell B. Travelers diarrhea among U.S. Navy and Marine Corps personnel during a Western Pacific deployment. Mil Med 1990 Mar; 155(2): 111–6

    CAS  Google Scholar 

  16. Hyams KC, Bourgeois AL, Merrell BR, et al. Diarrheal disease during Operation Desert Shield. N Engl J Med 1991 Nov 14; 325(20): 1423–8

    Article  PubMed  CAS  Google Scholar 

  17. Petruccelli BP, Murphy GS, Sanchez JL, et al. Treatment of travelers diarrhea with ciprofloxacin and loperamide. J Infect Dis 1992 Mar; 165: 557–60

    Article  PubMed  CAS  Google Scholar 

  18. Kuschner RA, Trofa AF, Thomas RJ, et al. Use of azithromycin for the treatment of Campylobacter enteritis in travelers to Thailand, an area where ciprofloxacin resistance is prevalent. Clin Infect Dis 1995 Sep; 21: 536–41

    Article  PubMed  CAS  Google Scholar 

  19. Taylor DN, Sanchez JL, Candler W, et al. Treatment of travelers diarrhea: ciprofloxacin plus loperamide compared with ciprofloxacin alone. Ann Intern Med 1991 May 1; 114(9): 731–4

    PubMed  CAS  Google Scholar 

  20. Haberberger RL, Mikhail IA, Burans JP, et al. Travelers diarrhea among United States military personnel during joint American-Egyptian armed forces exercises in Cairo, Egypt. Mil Med 1991 Jan; 156(1): 27–30

    PubMed  Google Scholar 

  21. Haberberger RL, Scott DA. Diarrheal disease aboard a U.S. Navy ship after a brief port visit to a high risk area. Mil Med 1994 Jun; 159(6): 445–8

    CAS  Google Scholar 

  22. Mattila L, Peltola H, Siitonen A, et al. Short-term treatment of travelers diarrhea with norfloxacin: a double-blind, placebo-controlled study during two seasons. Clin Infect Dis 1993 Oct; 17: 779–82

    Article  PubMed  CAS  Google Scholar 

  23. Gascon J, Vila J, Valls ME, et al. Etiology of travellers diarrhea in Spanish travellers to developing countries. Eur J Epidemiol 1993 March; 9(2): 217–23

    Article  PubMed  CAS  Google Scholar 

  24. Steffen R, Jori J, DuPont HL, et al. Treatment of travellers diarrhoea with fleroxacin: a case study. J Antimicrob Chemother 1993; 31: 767–76

    Article  PubMed  CAS  Google Scholar 

  25. DuPont HL, Capsuto EG. Persistent diarrhea in travelers. Clin Infect Dis 1996 Jan; 22: 124–8

    Article  PubMed  CAS  Google Scholar 

  26. DuPont HL, Sanchez JF, Ericsson CD, et al. Comparative efficacy of loperamide hydrochloride and bismuth subsalicylate in the management of acute diarrhea. Am J Med 1990 Jun 20; 88 (6A Suppl.): 15S–9S

    Article  PubMed  CAS  Google Scholar 

  27. Silberschmidt G, Schick MT, Steffen R, et al. Treatment of travellers diarrhoea: zaldaride compared with loperamide and placebo. Eur J Gastroenterol Hepatol 1995; 7: 871–5

    PubMed  CAS  Google Scholar 

  28. DuPont HL, Hornick RB. Adverse effect of lomotil therapy in shigellosis. JAMA 1973 Dec 24–31; 226(13): 1525–8

    Article  PubMed  CAS  Google Scholar 

  29. Salam I, Katelaris P, Leigh-Smith S, et al. Randomised trial of single-dose ciprofloxacin for travellers’ diarrhoea. Lancet 1994; 344: 1537–9

    Article  PubMed  CAS  Google Scholar 

  30. Kaplan JE, Masur H, Holmes KK, et al. Prevention of opportunistic infections in persons infected with human immunodeficiency virus. Clin Infect Dis 1997 Oct; 25 (3 Suppl.): 299S–335S

    Article  Google Scholar 

  31. DuPont HL, Ericsson CD, DuPont MW, et al. A randomized, open-label comparison of nonprescription loperamide and attapulgite in the symptomatic treatment of acute diarrhea. Am J Med 1990 Jun 20; 88 (6A Suppl.): 20S–3S

    Article  PubMed  CAS  Google Scholar 

  32. Barry M, Bia F. Pregnancy and travel. JAMA 1989 Feb 3; 261(5): 728–31

    Article  PubMed  CAS  Google Scholar 

  33. Kozicki M, Steffen R, Schär M. ‘Boil it, cook it, peel it or forget it’: does this rule prevent travellers diarrhoea? Int J Epidemiol 1985; 14(1): 169–72

    Article  PubMed  CAS  Google Scholar 

  34. Rademaker CM, Hoepelman IM, Wolfhagen MJ, et al. Results of a double-blind placebo-controlled study using ciprofloxacin for prevention of travelers diarrhea. Eur J Clin Microbiol Infect Dis 1989 Aug; 8(8): 690–4

    Article  PubMed  CAS  Google Scholar 

  35. Wenneras C, Svennerholm AM, Ahren C, et al. Antibody-secreting cells in human peripheral blood after oral immunization with an inactivated enterotoxigenic Escherichia coli vaccine. Infect Immun 1992 Jul; 60: 2605–11

    PubMed  CAS  Google Scholar 

  36. Savarino SJ, Brown M, Hall E, et al. Safety and immunogenicity of an oral, killed enterotoxigenic Escherichia coli-cholera toxin B subunit vaccine in Egyptian adults. J Infect Dis 1998 Mar; 177: 796–9

    Article  PubMed  CAS  Google Scholar 

  37. Ericsson CD, DuPont HL, Sullivan P, et al. Bicozamycin, a poorly absorbable antibiotic, effectively treats travelers’ diarrhea. Ann Intern Med 1983; 98: 20–5

    PubMed  CAS  Google Scholar 

  38. DuPont HL, Ericsson CD, Mathewson JJ, et al. Rifaximin, a nonabsorbed antimicrobial in the therapy of travelers’ diarrhea. Digestion. In press

  39. DuPont HL, Ericsson CD, Mathewson JJ, et al. Zaldaride maleate, an intestinal calmodulin inhibitor, in the therapy of travelers’ diarrhea. Gastroenterology 1993 Mar; 104: 709–15

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Baylor College of Medicine, Houston, Texas, USA

    Juan-Pablo Caeiro

  2. Internal Medicine Service, St Luke’s Episcopal Hospital, Houston, Texas, USA

    Herbert L. DuPont

Authors
  1. Juan-Pablo Caeiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Herbert L. DuPont
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Herbert L. DuPont.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Caeiro, JP., DuPont, H.L. Management of Travellers’ Diarrhoea. Drugs 56, 73–81 (1998). https://doi.org/10.2165/00003495-199856010-00007

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00003495-199856010-00007

Keywords

Search

Navigation