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Travellers’ Diarrhoea

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Manual of Travel Medicine

Abstract

Travellers’ diarrhoea (TD) is the most common illness of travellers to developing countries. In this chapter, we review the travel destinations with the highest incidence of TD, describe the main aetiologies and discuss the issues surrounding prevention and management of TD in some detail. We include discussion of current controversies regarding when self-treatment of TD with antibiotics should be advised. Chemoprophylaxis is rarely recommended, but we outline situations for which it may be considered. We also include a brief overview of management of diarrhoea in the returned traveller.

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Key Reading

  • Allen SJ, Martinez EG, Gregorio GV, Dans LF. Probiotics for treating acute infectious diarrhoea. Cochrane Database Syst Rev. 2010;(11):CD003048.

    Google Scholar 

  • Arcilla MS, van Hattem JM, Haverkate MR, Bootsma MC, van Genderen PJ, Goorhuis A, et al. Import and spread of extended-spectrum β-lactamase-producing Enterobacteriaceae by international travellers (COMBAT study): a prospective, multicentre cohort study. Lancet Infect Dis. 2017;17:78–85.

    Article  Google Scholar 

  • Barrett J, Brown M. Travellers’ diarrhoea. BMJ. 2016;353:i1937.

    Article  Google Scholar 

  • Briand V, Buffet P, Genty S, et al. Absence of efficacy of nonviable Lactobacillus acidophilus for the prevention of traveler’s diarrhea: a randomized, double-blind, controlled study. Clin Infect Dis. 2006;43(9):1170–5.

    Article  Google Scholar 

  • Connor B, Torresi J. Empiric management of acute TD abroad and in the recently returned traveler. In: Ericsson CD, DuPont HL, Steffen R, editors. Travellers diarrhoea. 2nd ed. Hamilton: BC Becker Inc.; 2007.

    Google Scholar 

  • Diemert DJ. Prevention and self-treatment of traveler’s diarrhea. Clin Microbiol Rev. 2006;19(3):583–94.

    Article  Google Scholar 

  • DuPont HL, Ericsson CD, Farthing MJ, Gorbach S, Pickering LK, Rombo L, et al. Expert review of the evidence base for prevention of travelers’ diarrhea. J Travel Med. 2009;16(3):149–60.

    Article  Google Scholar 

  • DuPont HL. Persistent diarrhea: a clinical review. JAMA. 2016;315(24):2712–23.

    Article  CAS  Google Scholar 

  • Ferrah N, Leder K, Gibney K. Review of the causes and management of chronic gastrointestinal symptoms in returned travellers referred to an Australian infectious diseases service. Aust Fam Physician. 2016;45(5):333–9.

    PubMed  Google Scholar 

  • Freedman DO, Weld LD, Kozarsky PE, Tamara Fisk T, et al. Spectrum of disease and relationship to place of exposure in ill returned travelers. N Engl J Med. 2006;354:119–30.

    Article  CAS  Google Scholar 

  • Greenwood Z, Black J, Weld L, O’Brien D, Leder K, Von Sonnenburg F, et al. Gastrointestinal infection among international travelers globally. J Travel Med. 2008;15(4):221–8.

    Article  Google Scholar 

  • Hu Y, Ren J, Zhan M, Li W, Dai H. Efficacy of rifaximin in prevention of travelers’ diarrhea: a meta-analysis of randomized, double-blind, placebo-controlled trials. J Travel Med. 2012;19(6):352–6.

    Article  Google Scholar 

  • Jiang ZD, DuPont HL. Etiology of travellers’ diarrhea. J Travel Med. 2017;24(Suppl_1):S13–6.

    Article  CAS  Google Scholar 

  • Kantele A, Lääveri T, Mero S, et al. Antimicrobials increase travelers’ risk of colonization by extended-spectrum betalactamase-producing Enterobacteriaceae. Clin Infect Dis. 2015;60(6):837–46.

    Article  Google Scholar 

  • Kantele A, Mero S, Kirveskari J, Lääveri T. Increased risk for ESBL-producing bacteria from co-administration of loperamide and antimicrobial drugs for travelers’ diarrhea. Emerg Infect Dis. 2016;22(1):117–20.

    Article  CAS  Google Scholar 

  • Leder K. Advising travellers about management of travellers’ diarrhoea. Aust Fam Physician. 2015;44(1–2):34–7.

    PubMed  Google Scholar 

  • McFarland LV. Meta-analysis of probiotics for the prevention of traveler’s diarrhea. Travel Med Infect Dis. 2007;5:97–105.

    Article  Google Scholar 

  • Murray CK, Blyth MDM. Acquisition of multidrug-resistant gram-negative organisms during travel. Mil Med. 2017;182(9–10):26–33.

    Article  Google Scholar 

  • Nair D. Travelers’ diarrhea: prevention, treatment, and post-trip evaluation. J Fam Pract. 2013;62(7):356–61.

    PubMed  Google Scholar 

  • Ng QX, Ho CYX, Shin D, Venkatanarayanan N, Chan HW. A meta-analysis of the use of rifaximin to prevent travellers’ diarrhoea. J Travel Med. 2017; 24(5).

    Google Scholar 

  • Pham M, Lemberg DA, Day AS. Probiotics: sorting the evidence from the myths. Med J Aust. 2008;188(5):304–8.

    Article  Google Scholar 

  • Riddle MS, Arnold S, Tribble DR. Effect of adjunctive loperamide in combination with antibiotics on treatment outcomes in traveler’s diarrhea: a systematic review and meta-analysis. Clin Infect Dis. 2008;47(8):1007–14.

    Article  CAS  Google Scholar 

  • Riddle MS, DuPont HL, Connor BA. ACG clinical guideline: diagnosis, treatment, and prevention of acute diarrheal infections in adults. Am J Gastroenterol. 2016;111(5):602–22.

    Article  CAS  Google Scholar 

  • Riddle MS, Connor BA, Beeching NJ, DuPont HL, Hamer DH, Kozarsky P, Libman M, Steffen R, Taylor D, Tribble DR, Vila J, Zanger P, Ericsson CD. Guidelines for the prevention and treatment of travelers’ diarrhea: a graded expert panel report. J Travel Med. 2017;24(Suppl_1):S57–74.

    Article  Google Scholar 

  • Shlim DR. Looking for evidence that personal hygiene precautions prevent traveler’s diarrhea. Clin Infect Dis. 2005;41(Suppl 8):S531–5.

    Article  Google Scholar 

  • Steffen R, Hill DR, DuPont HL. Traveler’s diarrhea: a clinical review. JAMA. 2015;313(1):71–80.

    Article  CAS  Google Scholar 

  • Steffen R. Epidemiology of travellers’ diarrhea. J Travel Med. 2017;24(Suppl_1):S2–5.

    Article  Google Scholar 

  • Swaminathan A, Torresi J, Schlagenhauf P, Thursky K, et al. for the GeoSentinel Surveillance Network. Pathogens and host risk factors associated with infectious gastrointestinal disease in returned international travelers. J Infect. 2009;59:19–27.

    Article  Google Scholar 

  • Tribble DR, Sanders JW, Pang LW, Mason C, et al. Traveler’s diarrhea in Thailand: randomized, double-blind trial comparing single-dose and 3-day azithromycin- based regimens with a 3-day levofloxacin regimen. Clin Infect Dis. 2007;44:338–46.

    Article  CAS  Google Scholar 

  • Tribble DR. Antibiotic therapy for acute water diarrhea and dysentery. Mil Med. 2017;182(S2):17–25.

    Article  Google Scholar 

  • Wingate D, Phillips SF, Lewis SJ, et al. Guidelines for adults on self-medication for the treatment of acute diarrhea. Aliment Pharmacol Ther. 2001;15(6):773–82.

    Article  CAS  Google Scholar 

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Torresi, J. et al. (2019). Travellers’ Diarrhoea. In: Manual of Travel Medicine. Springer, Singapore. https://doi.org/10.1007/978-981-13-7252-0_4

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  • DOI: https://doi.org/10.1007/978-981-13-7252-0_4

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-13-7251-3

  • Online ISBN: 978-981-13-7252-0

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