MANAGEMENT OF TRAVELERS DIARRHEA

The most common health problem encountered in international travellers to tropical and subtropical areas is diarrhoea, Even though it is not a life-threatening condition, it may influence deeply the quality of a vacation or the success of a business trip. The majority of cases of travellers' diarrhoea are due to bacterial pathogens, but viruses and parasites have also been implicated in a minority of patients. It is advocated that travellers with diarrhoea provide themselves with sourc es of salt (crackers or soup) and mineral water, to prevent and treat dehydration. Otherwise, treatment recommendations follow illness sever ity, For mild cases, symptomatic relief alone can be recommended. Lope ramide is an effective agent improving diarrhoea and associated sympto ms, For moderate diarrhoea (requiring a forced change in itinerary) co mbination therapy is advised using a fluoroquinolone together with lop eramide, Seven diarrhoea [fever >38 degrees C, dysentery (bloody stool s) or incapacitating symptoms] should prompt the voyager to take an an tibiotic alone for 3 to 5 days. Loperamide is relatively contraindicat ed in these cases. For the minority of patients receiving chemoprophyl axis to prevent travellers' diarrhoea, fluoroquinolones taken once a d ay while in the area at risk produce the highest protection rate (up t o 95%). However, most authorities do not recommend routine prophylaxis for travellers.