Occurrence and self-treatment of diarrhea in a large cohort of Americans traveling to developing countries

There is little information available regarding traveler's diarrhea that af fects a large number of Americans who differ widely in age and travel desti nation, and little or no information exists on self-treatment. This paper d escribes the clinical features, self-treatment, and outcome of diarrhea in 784 (95% follow-up) Americans who traveled for less than or equal to 90 day s, and who received detailed pre-travel advice. Diarrhea was reported by 46 %. Of these, 34% (n = 270) had traveler's diarrhea (TD) defined as greater than or equal to 3 unformed stools/day +/- enteric symptoms or < 3 stools/d ay with <greater than or equal to> 1 enteric symptom, and 11% (n = 88) had loose motions (LM). Diarrhea was often severe and nearly a quarter of peopl e with TD experienced fever and vomiting and 35% were required to alter the ir plans. The duration of travel and the destination itself were the strong est influences on diarrhea. Most travelers treated the illness themselves, whether or not they had LM (72%) or TD (83%). Those with LM took an antimot ility agent or bismuth subsalicylate alone more frequently than those with TD (71% versus 48%, P < 0.002). Conversely, antibiotics were taken more fre quently by those with TD (47% versus 27%, P < 0.03). Overall, 83% indicated self-treatment was effective (91% with LM and 80% with TD). Diarrhea is co mmon despite pre-travel advice. Because travelers usually treat themselves, they should be provided with clear instructions on appropriate self-treatm ent.