Prevention and Treatment of Traveler’s Diarrhea

Abstract

Diarrhea, mostly due to bacterial infection of the gut, is the most frequent health complaint in the international traveler, affecting 20–70% of the traveling population depending on the destination and other factors. It is usually benign and self-limiting in nature, but symptoms may occasionally be distressing causing modifications of normal activities and sometimes confinement to bed or hospitalization. Prevention of traveler’s diarrhea should ideally be based on dietary restrictions, but experience shows that this target is extremely difficult to achieve. Antibiotic chemoprophylaxis should be restricted to selected groups of travelers at risk of severe complications of diarrhea or when diarrhea-driven alterations of planned activities are highly undesirable (crit- ical trips). The effectiveness of alternative prophylactic approaches, such as vaccination or the use of probiotics, still awaits confirmation. Treatment of mild diarrheal cases without intestinal symptoms may be limited to rehydration with or without antimotility agents. When antibiotic therapy is considered, non-absorbable antibiotics, such as rifaximin, may be considered a valid alternative to systemic antibiotics to treat uncomplicated cases, leaving fluoroquinolones and/or azithromycin for use in more severe cases or when invasive pathogens are suspected. Indeed, therapeutic use of doxycycline and trimethoprim-sulfamethoxazole (TMP-SMX) is limited by widespread resistance of many enteropathogens. The addition of loperamide or other antimotility agents usually provides symptom relief and further shortens the duration of illness and may be therefore safely adopted in the healthy adult unless dysentery is present.

Preventive Effects of Different Probiotic Formulations on Travelers’ Diarrhea Model in Wistar Rats

“…These probiotics have been tested on a new original model of TD developed in the male Wistar rats by an oral administration of a strain of enterotoxigenic E. coli bacteria. This new experimental model of TD led to some of the symptoms observed in humans: diarrhea, fever, body weight decrease due to reduction of food and water consumption and production of inflammatory cytokines [1,2,6]. These symptoms last for 2-3 days after induction of TD, in contrast with the existing model of diarrhea induced by an oral administration of castor oil, which only produces diarrhea lasting for 4 h [40,[42][43][44][45][46][47].…”

“…Traveler's diarrhea (TD), usually benign and self-limiting in nature, is the most frequent health complaint in the international traveler, affecting 20-70% of the traveling population from the industrialized world to developing countries every year [1,2]. Traveler's-associated diarrhea is mostly due to a bacterial infection of the gut due to pathogens that proliferate and invade or produce toxins.…”

“…However, antibiotics are not recommended for widespread use and there is a need for more cost-effective alternative treatments [6]. The effectiveness of alternative prophylactic approaches (such as vaccination or the use of probiotics) is under development [2].…”

Enhanced susceptibility to Trichuris muris infection of B10Br mice treated with the probiotic Lactobacillus casei

“…Studies of paediatric diarrhea show substantial evidence of clinical benefits from probiotic therapy in patients with viral gastroenteritis, and data on LGG treatment for Clostridium difficile diarrhea appear promising [15,16]. However, data to support the use of probiotics for prevention of traveler's diarrhea are more limited and yield conflicting results [17,14]. The ability of probiotics, and particularly lactobacilli, to control parasitic infections has also been evidenced in in vivo studies with Crytosporidium [18][19][20], Eimeria acervulina [21] and Eimeria spp.…”

Reisediarrhö

“…Eine Befragung von kanadischen Reisenden in der Abflughalle nach Mexico zeigte, dass Wissen über Reisedurchfall durchaus vorhanden ist, denn knapp die Hälfte hatte medizinische Information erhalten, mehr denn 80% beantworteten die Fragen zu riskanten Nahrungsmitteln richtig, nur 43% wussten von Viren als Krankheitserregern der Reisediarrhö und 56% erachteten Händewaschen als eine effektive Hygienemaßnahme[16]. Es klafft jedoch eine Lücke bei der praktischen Umsetzung: Finnische und Schweizer Reisende nach Ostafrika hielten sich bis zu 95% nicht an diese Richtlinien[3]. Rotarix (Glaxo Smith Kline) und RotaTeq (Sanofi Pasteur MSD).…”