Travelers’ diarrhea prevention

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). 

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

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

DuPont HL, Jiang ZD, Ericsson CD, de la Cabada F, Shi K, DuPont MW, Martinez-San-doval F Rifaximin, a nonabsorbed(0.5%) antibiotic, prevents travelers diarrhea (TD). Gastroenterology 2004 126(suppl 2) A 12. 

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

Centers for Disease Control and Prevention. Health Information for International Travel 1999-2000. Atlanta, Department of Health and Human Services (also www.cdc.gov/travel/diarrhea.htrri). 

Thrombolytic agents a need for improvement Thyroid preparations Trace minerals essential for health Traveler s diarrhea prevention of Tuberculosis treatment of Upper respiratory tract infection treatment of Urinary tract infections treatment of Uveitis management of Vaginal candidiasis treatment of Vasodilators effects on cardiac output (CO)... 

Dupont, H.L. and Eriesson, C.D. 1993. Drug-Therapy-Prevention and Treatanent of Travelers Diarrhea. JVew ng/JA/erf 325(25), 1821-1827. 

Rifaximin is available in Europe for the treatment of acute intestinal bacterial infections, hepatic encephalopathy, bacterial overgrowth syndrome, diverticular disease of the colon, and for the prevention of infections after colorectal surgery [3, 4]. Rifaximin is also licensed in Mexico, Asia and Northern Africa and has recently been approved in USA for the treatment of traveler s diarrhea. 

After the submission of this paper several publications have appeared in the literature that reinforce the role of rifaximin in the treatment of infectious diarrhea [1]. An entire issue of the Journal of Travel Medicine devoted to the use of this antibiotic in the treatment of traveler s diarrhea (TD) has been published [2-5], In addition, a recent paper from our laboratory [6] confirmed the rifaximin efficacy also in enteroaggregative Escherichia coli-mediated TD. Furthermore, in a randomized, double-blind, placebo-con-trolled study [7] even once daily administration of the antibiotic proved to be capable of preventing TD. Finally, Lawler and Wallace [8] recently reviewed the treatment options for bacterial diarrhea and considered rifaximin a useful addition to our therapeutic armamentarium. 

Diarrhea is a well-known complication of antibiotic therapy. Rates of antibiotic-associated diarrhea (AAD) vary from 5 to 25%. Some antibiotics are more likely to cause diarrhea than others, specifically, those that are broad spectrum and those that target anaerobic flora. This paper reviews the effects of antibiotics on the fecal flora as well as host factors which contribute to AAD. Clinical features and treatment of AAD are also described. Prevention of AAD rests on wise antibiotic policies, the use of probiotics and prevention of acquisition in the hospital setting. Data from clinical trials suggest that poorly absorbed antimicrobials might have a decreased risk of causing AAD and Clostridium difficile-associated disease, as concluded from studies of antibiotics used for preoperative bowel decontamination and poorly absorbed antibiotics used for traveler s diarrhea. Controlled trials would prove this but are not yet available. Probiotics may be a good adjunct to poorly absorbed antibiotics to minimize the risk of diarrhea associated with antibiotics. 

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. 

Another group of compounds, the tetracyclines, are made by fermentation procedures or by chemical modifications of the natural product. The hydrochloride salts are used most commonly for oral administration and are usually encapsulated because of their bitter taste. Controlled catalytic hydrogenolysis of chlortetracycline, a natural product, selectively removes the 7-chloro atom and produces tetracycline. Doxycycline and minocycline are other important antibacterials. Tetracycline can be prescribed for people allergic to penicillin. Doxycycline prevents traveler s diarrhea. Tetracyclines help many infections including Rocky Mountain spotted fever, Lyme disease, urinary tract infections, bronchitis, amoebic dysentery, and acne. 

Uniabeled Uses Treatment of atypical mycobacterial infections, gonorrhea, malaria, rheumatoid arthritis prevention of Lyme disease prevention or treatment of traveler s diarrhea. 

In spite of the lack of comparative trials, nonprescription bismuth compounds are widely used by patients for the nonspecific treatment of dyspepsia and acute diarrhea. Bismuth subsalicylate also is used for the prevention of traveler s diarrhea (30 ml or 2 tablets four times daily). 

Bismuth subsalicylate (BSS) is used widely in humans for treatment of diarrhea and is specifically recommended for the prevention of traveler s diarrhea. The precise mechanism of action remains undetermined and although the end result of treatment with BSS is reduction in diarrhea (Figueroa-Quintanilla et al 1993), its effect is probably not related to a direct antisecretory mechanism. Salicylates have been shown to stimulate intestinal fluid and electrolyte absorption per se but it is likely that, in many cases of colitis, resolution of inflammation and restoration of a normal surface epithelium is required to restore mucosal function. When used as pretreatment or coadministered, BSS significantly reduced the fluid secretory response to E. coli LT enterotoxin and cholera toxin in intestinal loops of rabbits and pigs (Ericsson et al 1990). However, when administered even 5 min after the enterotoxins, BSS had no significant effect on enterotoxin-stimulated intestinal secretion. These results suggest that BSS adsorbs or neutralizes bacterial enterotoxins but does not alter the effect of enterotoxins once they have bound to intestinal mucosa. BSS also modulates normal... 

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. 

Bismuth subsalicylate suspension has been evaluated in the treatment of secretory diarrhea of infectious etiology as well. In a dose of 30 mL every 30 minutes for eight doses, unformed stools decrease in the first 24 hours. Bismuth subsalicylate may also be effective in preventing traveler s diarrhea. 

Ansdell VE, Ericsson CD. Prevention and empiric treatment of traveler s diarrhea. Med Clin North Am 1999 83 945-973. 

Patient education and prevention strategies are important in preventing and treating traveler s diarrhea. Prophylaxis with antibiotics is appropriate in certain situations. 

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