Travelers diarrhea

Rifaximin Diarrhea Treatment - Infectious diarrhea Bacterial diarrhea - Travelers diarrhea... 

Bismuth subsalicylate is often used for treatment or prevention of diarrhea (traveler s diarrhea) and has antisecretory, antiinflammatory, and antibacterial effects. Bismuth subsalicylate contains multiple components that might be toxic if given in excess to prevent or treat diarrhea. 

Mcfarland, L. V. (2007). Meta-analysis of probiotics for the prevention of traveler s diarrhea. Travel Medicine and Infectious Disease, 5, 97-105. 

Bismuth subsahcylate [14882-18-9] Pepto-Bismol, is a basic salt of varying composition, corresponding approximately to i9-H0CgH4C02(Bi0). Like a number of other insoluble bismuth preparations, it is not currentiy approved in the United States for the treatment of peptic ulcer disease but is under active investigation for this purpose (180). It does appear to be effective for the rehef of mild diarrhea and for the prevention of travelers diarrhea (181). The ready availabiUty of this dmg, however, may lead to its ovemse and result in toxic effects caused by both the saUcylate and bismuth components. It has been suggested that bismuth subsahcylate is somewhat effective in the symptomatic treatment of isosporiasis, a disease caused by the intracellular parasite Isospora belli (182). 

Bacteria are likely precipitants in many other cases including Escherichia coli, Salmonella species, Shigella species, Vibrio cholerae, and Clostridium difficile. The term dysentery has often been used to describe some of these bacterial infections when associated with serious occurrences of bloody diarrhea. Additionally, acute diarrheal conditions can be prompted by parasites-protozoa such as Entamoeba histolytica, Microsporidium, Giardia lamblia, and Cryptosporidium parvum. Most of these infectious agents can be causes of traveler s diarrhea, a common malady alflicting travelers worldwide. It usually occurs during or just after travel subsequent to the ingestion of fecally-contaminated food or water. It has an abrupt onset but usually subsides within 2 to 3 days. 

Although diarrhea can often be attributed to a specific mechanism, some patients develop diarrhea due to overlapping mechanisms. For example, malabsorption syndromes and traveler s diarrhea are associated with both secretory and osmotic diarrhea. 

Patients with diarrhea should be questioned about the onset of symptoms, recent travel, diet, source of water, and medication use. Other important considerations include duration and severity of the diarrhea along with an accounting of the presence of associated abdominal pain or vomiting, blood in the stool, stool consistency, stool appearance, stool frequency, and weight loss. Although most cases of diarrhea are self-limited, infants, children, elderly persons, and immunocompromised patients are at risk for increased morbidity. 

Empiric antibiotic therapy is an appropriate approach to traveler s diarrhea. Eradication of the causal microbe depends on the etiologic agent and its antibiotic sensitivity. Most cases of traveler s diarrhea and other community-acquired infections result from enterotoxigenic (ETEC) or enteropathogenic (EPEC) Escherichia coli. Routine stool cultures do not identify these strains primary empiric antibiotic choices include fluoroquinolones such as ciprofloxacin or levofloxacin. Azithromycin may be a feasible option when fluoroquinolone resistance is encountered. 

Travelers diarrhea is most commonly caused by bacteria such as Shigella, Salmonella, Campylobacter, and Escherichia coli, although viruses are being recognized increasingly as a significant cause of travelers diarrhea as well. 

Education of travelers about high-risk food items is the key to the prevention of travelers diarrhea. 

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

MK is a 15-year old high school student who had traveled to Mexico as part of a school group to practice his Spanish language skills. While in Mexico, he was careful in not drinking any local water and only consumed warm or heated food and soda. He is seen in the travel clinic with complaints of some "explosive" crampy diarrhea and has had constipation alternating with diarrhea for the last 2 weeks. MK indicates that his stools have been foul-smelling. 

Travelers diarrhea An acute infectious diarrhea that afflicts travelers. The disease is characterized by the presence of at least three loose stools within 24 hours that is associated with nausea, vomiting, abdominal pain, fecal urgency, or dysentery. 

Adachi JA, Ostrosky-Zeichner L, DuPont HL, Ericsson CD Empirical antimicrobial therapy for traveler s diarrhea. Clin Infect Dis 2000 31 1079-1083. 

DuPont HL, Ericsson CD Prevention and treatment of traveler s diarrhea. N Engl J Med 1993 328 1821-1827. 

Ericsson CD Travelers diarrhea. Epidemiology, prevention, and self-treatment. Infect Dis Clin North Am 1998 12 285-303. 

Gorbach SL, Edelman R Traveler s diarrhea National Institutes of Health Consensus Conference. JAMA 1985 253 2700-2704. 

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