Traveler’s Diarrhea

For Trip <4 weeks:

  •   Major pathogens:
    • Entrotoxigenic Escherichia coli (ETEC)
    • Campylobacter Spp.
    • Shigella Spp.
    • Samonella Spp.
  • Prophylaxis:
    • Dukoral® vaccine
      • Consists of killed Vibrio cholerae and a recombinant form of the cholera toxin B-subunit
      • Short-term protection against ETEC (67% over 3 months)
      • Side-effects minimal, cost-effective
    • Bismuth subsalicylate (Pepto-Bismol) 30 mL po QID
      • Not for children with viral illnesses (Reyes), patients on doxycycline for malaria prophylaxis or warfarin
    • Antibiotics not recommended given risks (e.g. C. difficile) and ease of treating diarrheal episodes
  • Treatment:
    • Bismuth subsalicylate (Pepto-Bismol) 30 mL q30 minutes, Max 8 doses/day
      • Not for children with viral illnesses (Reyes), patients on doxycycline for malaria prophylaxis or warfarin
    • Loperamide 4 mg after first loose stool with 2 mg after each subsequent stool, Max 16 mg/d
      • Not for bloody diarrhea or other systemic signs of illness
    • Ciprofloxacin 500 mg po BID x 1-3 days
    • Azithromycin 1000 mg po x 1 dose
      • Preferred in children, pregnant women and if visiting a ciprofloxacin-resistant area such as Asia or South-East Asia

Reference: http://thischangedmypractice.com/travellers_diarrhea/