Traveler's Diarrhea in the Pediatric Population: Etiology and Impact

Abstract

Children who travel are at risk of developing the same, well-known illnesses that affect adult travelers. The etiology, treatment, and actual risk of these illnesses are not well defined in children. The limited amount of data available forces clinicians to extrapolate appropriate treatment for children. Recommendations for children have not been standardized. The role and judicious use of antimicrobials in the treatment of pediatric traveler's diarrhea have evolved during recent decades and will be reviewed here. The past 2 decades have seen an unprecedented, sustained growth in travel. The epidemiology related to travel medicine has evolved to describe travelers and their illnesses more specifically. The development of the field of travel medicine has led to greater understanding and improved, targeted treatment of travel-related illnesses. Most of the data available today describe traveler's diarrhea in adults. Children traveling to distant destinations from their home country have not been well studied, yet treatment parameters exist in practice and will be reviewed here.

Preparing Families With Children for International Travel

“…37 Unfortunately, S. paratyphi A, a clinically indistinguishable pathogen for which no vaccine is available, has been observed to cause increasing rates of infections. 38 Enterotoxigenic Escherichia coli is the most commonly identified organism causing traveler's diarrhea. 38 Children and adults are equally susceptible to this illness but data on children remains scant.…”

“…38 Enterotoxigenic Escherichia coli is the most commonly identified organism causing traveler's diarrhea. 38 Children and adults are equally susceptible to this illness but data on children remains scant. Antimicrobial therapy is the backbone of therapy for traveler's diarrhea.…”

“…At this time, the prevalent strains and resistance patterns favor empiric self-treatment with azithromycin at the onset of symptoms. 38 The risks and benefits of self-treatment will be covered in further detail at the end of this article.…”

Protection of Travelers

“…Although there is little response to polysaccharide vaccines in children less than 2 years of age, some short-term protection to serogroup A may be provided by two doses of the vaccine given 3 months apart; consequently, this is advised for infants from 3 to All references are available online at www.expertconsult.com incidence and severity of travelers' diarrhea are age-dependent, with the highest rates, longest duration, and greatest severity occurring in infants and children under 3 years of age. 63,64 Children's stools may normally can be quite variable; consequently, travelers' diarrhea is defined as ≥2-fold increase in the frequency of unformed stools, lasting at least 2 to 3 days. The infectious causes of travelers' diarrhea in children and adults predominantly are bacterial and include enterotoxigenic Escherichia coli (ETEC), which is the most common cause, enteroaggregative Escherichia coli (EAEC), Salmonella, Campylobacter, Shigella, enteropathogenic Escherichia coli (EPEC), and, rarely, shigatoxin-producing Escherichia coli (STE).…”

Diarrea del viajero

“…Se detectan enterovirus como los Rotavirus, una de las causas más frecuente de diarreas y con mayor morbilidad en la edad infantil 19 . Los virus Norwalk se han aislado hasta en un 10% de los casos de diarreas, siendo frecuente su asociación con ETEC 20 , y también se han detectado en brotes enté-ricos epidémicos entre pasajeros de cruceros 21 .…”