Travellers diarrhoea

Frequency and nature of stools Rapid onset. Watery stools, passed frequently Acute diarrhoea Traveller s diarrhoea... 

Traveller s diarrhoea may be eaused by one of many gastrointestinal pathogens (Table 6.4). However, enterotoxigenic Escherichia coli is the most common pathogen. Whilst it is generally short-lived, traveller s diarrhoea can seriously mar a brief period abroad, be it for holiday or business purposes. Although not universally accepted, the use of short-course co-trimoxazole or quinolone such as norfloxacin can abbreviate an attack in patients with severe disease. 

Lima AA Tropical diarrhoea New developments in traveller s diarrhoea. Curr Opin Infect Dis 2001 14 547-552. 

De Bruyn G, Hahn S, Berwick A. Antibiotic treatment for travellers diarrhoea. Cochrane Database Syst Rev 2000. 

Antibiotic therapy is justified where there is suspicion of giardiasis (metronidazole) and bismuth subsalicylate is effective in acute travellers diarrhoea, as are agents such as ciprofloxacin. In tropical areas where there is suspicion of amoebic disease metronidazole should be given early. 

Cummings, J.H., Christie, S., and Cole, T.J., A study of fructo-oligosaccharides in the prevention of travellers diarrhoea, Aliment. Pharm. Then, 15, 1139-1145, 2001. 

Q3 Which organisms are most frequently associated with traveller s diarrhoea ... 

Q4 What factors might have made Mrs Kaye more likely than some other travellers to develop diarrhoea ... 

Q4 Mrs Kaye may be at risk because this was her first visit abroad and possibly she was particularly affected by a change in diet or did not take the usual precaution of drinking bottled water and avoiding salads and unwashed fruit. Mrs Kaye also takes ranitidine for indigestion and there is some evidence that patients with reduced gastric acid, including those who take H2 antagonists such as ranitidine, are at increased risk of traveller s diarrhoea. 

Absorbents such as kaolin are not recommended for traveller s acute diarrhoea. 

Traveller s diarrhoea, which affects people travelling outside their own countries, usually lasts two to five days. It involves three or four unformed stools in 24 hours and at least one other symptom, such as faecal urgency, fever, nausea, vomiting, abdominal pain or cramps. 

The most frequent cause of traveller s diarrhoea is E. coli but other bacterial causes include C. jejuni and Salmonella species. A minority of cases appear to involve viral infection, such as rotavirus. 

Escherichia coli is a normal inhabitant of the bowel but some enterotoxigenic strains are pathogenic and are frequently a cause of travellers diarrhoea. A quinolone, e.g. ciprofloxacin, is the drug of choice in most high-risk parts of the world for a severe attack (see Travellers diarrhoea, p. 644). Antimicrobials are not generally given for prophylaxis but, when it is indicated, a quinolone should be used. 

Symptomatic control of acute nonserious diarrhoea, e.g. travellers diarrhoea (codeine)... 

Acute watery diarrhoea in adults can usually be controlled by oral rehydration solutions and one of the antimotility drugs, although in mild cases the abdominal bloating produced by the latter may be less acceptable than the loose stools. While diarrhoea usually lasts only 2-3 days, this may stiU be socially inconvenient, and if s5rmptomatic remedies fail, an aminoquinolone, e.g. ciprofloxacin 500 mg b.d. will be effective. The use of antimicrobials for travellers diarrhoea continues to evoke controversy (see below) but most sufferers will appreciate the relief that even one or two tablets can bring. 

Prophylactic antimicrobial therapy has been shown to reduce the incidence of attacks of diarrhoea but its routine use carries the risk of hindering the diagnosis of serious infection. A wider issue is the possible development and spread of antibiotic-resistant organisms. Thus any benefits to the individual must be weighed against the risk to the community in the future. In most instances prophylactic antimicrobials should not be used but ciprofloxacin (500 mg once daily) may be justified for individuals who must remain well while travelling for short periods to high-risk areas. 

Farthing. M.J.G. (1993) Travellers diarrhoea mostly due to bacteria and difficult to prevent. Br. Med.. . 306,1425-1426, de Luca, A. era/. (1996) Insights into opioid action in the Intestinal tract. Pharmacol Ther..%%. 103-115. 

This is the term given to diarrhoea experienced by travellers or holidaymakers. Causes, and the severity of symptoms, vary with location. 

Up to 15% of patients with traveller s diarrhoea have dysentery (bloody diarrhoea). 

Blood and/or mucus in stool Traveller s diarrhoea Inflammatory bowel disease... 

Begins during or soon after return from visit to tropical or subtropical country Traveller s diarrhoea... 

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