Preparing patients to travel abroad safely part 4: Reducing risk of accidents, diarrhea, and sexually transmitted diseases

OBJECTIVE To present evidence-based recommendations on traveling abroad saf ely so family physicians can advise travelers on how to reduce risk of acci dents, diarrhea, and sexually transmitted diseases (STDs) and how to treat diarrhea themselves if medical care is unavailable. QUALITY OF EVIDENCE A MEDLINE search from 1990 to November 1998 found 163 a rticles on travel and accidents, 504 on travel and diarrhea, and 42 on trav el and STDs. Titles and abstracts were reviewed, and randomized controlled trials (RCTs) and systematic reviews were sought. The Cochrane Collaboratio n database of systematic reviews and meta-analyses was searched for studies relevant to family physicians. MAIN MESSAGE For preventing diarrhea, RCTs demonstrate that bismuth subsali cylate, doxycycline, ciprofloxacin, and trimethoprim-sulfamethoxazole are u seful prophylactics. Once travelers have diarrhea, RCTs show that loperamid e and zaldaride reduce symptoms and duration; quinolones, ciprofloxacin, no rfloxacin, and oral aztreonam reduce abdominal symptoms and time to last li quid stool by several days; azithromycin is effective in treatment of cipro floxacin-resistant Campylobacter; and trimethoprim-sulfamethoxazole is effe ctive in treating cyclospora. There are no RCTs of preventing accidents and STDs abroad. Health Canada has issued a statement summarizing the risks of acquiring STDs abroad. CONCLUSION Family physicians can advise their patients on how to reduce ris k of travelers' diarrhea and how to treat it themselves on holiday. There i s expert advice on how to reduce risk of STDs.