Diarrhea in travel

Gomi et al. [4] studied patients with diarrhea acquired in India, Mexico, Jamaica and Kenya, Sierra et al. [5] studied diarrhea in travelers returning to Spain from multiple locations, and DuPont et al. [6] studied patients with diarrhea acquired in Mexico. EAEC = Enteroaggrega-tiveJT. coli. 

Infante RM, Ericsson CD, Jiang ZD, Ke S, Steffen R, Riopel L, Sack DA, DuPont HL Enteroaggregative Escherichia coli diarrhea in travelers Response to rifaximin therapy. Clin Gastroenterol Hepatol 2004 2 135-138. 

Okhuysen PC. Current concepts in travelers diarrhea Epidemiology, antimicrobial resistance and treatment. Curr Opin Infect Dis 2005 18 522-526. 

Thielman NM, Guerrant RL Persistent diarrhea in the returned traveler. Infect Dis Clin North Am 1998 12 489-501. 

Adachi J, Jiang ZD, Mathewson JJ, Verenkar MP, Thompson S, Martinez-Sandoval F, Steffen R, Ericsson CD, DuPont HL Enteroaggre-gative Escherichia coli as a major etiologic agent in traveler s diarrhea in 3 regions of the world. Clin Infect Dis 2001 32 1706-1709. 

DuPont HL, Ericsson CD, Mathewson JJ, de la Cabada FJ, Comad D Oral aztreonam, a poorly absorbed yet effective therapy for bacterial diarrhea in US travelers to Mexico. JAMA 1992 267 1932-1935. 

Rifaximin appeared to be effective and safe in both adults and children. Not only do these data support the efficacy of a nonabsorbable antibiotic in the treatment of diarrhea, the lack of absorption and degree of safety reported to date support the likelihood that rifaximin will be safe to use in pregnant women. Currently, the drugs of choice for the treatment of bacterial diarrhea, especially travelers diarrhea, are the fluoroquinolones, which are contraindicated in pregnancy. While rifaximin will likely never be adequately studied in pregnancy, it should be safe. 

Nonabsorbable antibiotics are appealing because they have fewer systemic side effects and may be safer for children and pregnant women as well as in patients with renal and hepatic dysfunction. One such antibiotic, aztreonam, showed little effect on anaerobic flora in human volunteers, producing most of its effect on the aerobic flora [49, 50], A trial showed efficacy of aztreonam for traveler s diarrhea, where most pathogens are aerobes [51]. While there are no data on rates of AAD for nonabsorbable antibiotics and C. difficile, these would likely be decreased. Given the preservation of the anaerobic flora, another poorly absorbed antibiotic, bicozamycin, has efficacy in traveler s diarrhea with its major effect being on fecal aerobes [52],... 

Travelers diarrhea in adults - Travelers diarrhea in adults caused by susceptible strains of enterotoxigenic E. coli. 

There is some evidence that bismuth subsalicylate can be effective in travelers diarrhea due to Escherichia coli and for nonspecific diarrhea by such mechanisms as binding bacterial toxins, bactericidal action and local anti-inflammatory effects. 

Colloidal bismuth compounds Subsalicylate and citrate salts available. OTC preparations popular and have some value in travelers diarrhea due to adsorption of toxins... 

Indications IV Infusion Prophylaxis and treatment of Pneumocystis car/n/ pneumonia Shigellosis Severe or complicated urinary tract infections Tablets Prophylaxis and treatment of Pneumocystis carinii pneumonia Acute exacerbation of chronic bronchitis Urinary tract infections Travelers diarrhea in adults Shigellosis Acute otitis media ... 

Acute viral diarrheal illness often occurs in day care centers and nursing homes. As person-to-person contact is the mechanism by which viral disease spreads, isolation techniques must be initiated. For bacterial, parasite, and protozoal infections, strict food handling, sanitation, water, and other environmental hygiene practices can prevent transmission. If diarrhea is secondary to another illness, controlling the primary condition is necessary. Antibiotics and bismuth subsalicylate are advocated to prevent traveler s diarrhea, in conjunction with treatment of drinking water and caution with consumption of fresh vegetables. 

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