Clinical Presentation and Diagnosis of Traveler Diarrhea

• Frequent, loose stools

• Associated with nausea and vomiting

• Abdominal pain

• Fecal urgency

• Signs and symptoms related to specific causative pathogen

Although antimotility agents are effective at shortening the duration of illness, they do not eradicate microorganisms and should not be used in moderate to severe cases with systemic symptoms unless in combination with an antibiotic. The combination of an antimotility agent and an antibiotic can reduce the duration of illness to a few hours.25

^^ Education of travelers about high-risk food items is the key to the prevention of traveler's diarrhea. Slogans such as "Peel it, boil it, cook it, or forget it" can help to remind travelers of the foods that may be contaminated. Prophylaxis of traveler's diarrhea with antibiotics is effective but should be restricted to individuals who have a repeated history of traveler's diarrhea; cannot afford to make travel alterations (e.g., business trip, competitors, or politicians); have a predisposing factor for traveler's diarrhea, such as achlorhydria, gastrectomy, or inflammatory bowel disease; or are im-

munosuppressed. The use of antibiotics for prophylaxis is not widely recommended because of the selective pressure for the development of resistance, adverse effects, effect on the normal flora of the GI tract, and cost. The fluoroquinolones are used when prophylaxis is necessary. However, rifaximin may represent an ideal option for prophylaxis of traveler's diarrhea, with virtually no systemic absorption and an excellent safety profile, although it is not approved by the FDA for this indication. Bismuth subsalicylate 525 mg one to four times daily is also effective for traveler's diarrhea prophylaxis. No effective vaccines exist for traveler's diarrhea.

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