Definition of Traveler’s Diarrhea (TD)
- Mild : diarrhea that is tolerable, is not distressing, and does not interfere with planned activities.
- Moderate: diarrhea that is distressing or interferes with planned activities. Diarrhea accompanied by nausea, cramping, vomiting, low-grade fever.
- Severe: diarrhea that is incapacitating, or completely prevents planned activities; high fever, frequent vomiting, severe cramping. All stools that are grossly bloody are considered severe (dysentery).
- Persistent: diarrhea lasting > 2 weeks.
Current recommendations for treatment are based on these categories, a change from treating TD based on the number of loose stools in a day.
- Antibiotics should not be used for prevention routinely in travelers.
- Antibiotics should be considered for travelers at risk of health related complications from TD.
- Bismuth subsalicylate (BSS, Pepto-Bismol) may be considered for prevention. Dosage: 2 tablets 4x/day, or 30 ml of liquid. Possible side effects: black tongue, constipation, some drug interactions.
- Antibiotics not recommended.
- Loperamide or BSS may be considered.
- Antibiotics may be used to treat cases of moderate TD.
- Azithromycin 1 Gram for one dose may be given, or 500 mg once a day x 3 days. Take with food to minimize upset stomach.
- Fluorquinolones (Cipro, Levaquin) may be used, however emergence of significant resistance in SE Asia, potential for adverse reduction in intestinal healthy microbiota, and musculoskeletal consequences contribute to an uncertain risk-benefit profile.
- Loperamide along with antibiotics, or as a single monotherapy has also been shown to be effective.
- Antibiotics should be used to treat severe TD.
- Azithromycin is preferred, in a single dose regimen.
- Fluorquinolones (Cipro, Levaquin) may be used to treat non-dysenteric diarrhea, but with a weak recommendation.
- Rifaximin may be used to treat severe TD
There is not enough data currently to recommend probiotics or pre-biotics to prevent or treat TD.
There is increasing evidence that untreated TD with prolonged diarrhea may cause increase incidence of Irritable Bowel Syndrome (IBS).
- CDC Yellow Book on Traveler’s Diarrhea
- Riddle, M., Conner, B., Beeching, N., Dupont, H., Hamer, D., Kozarsky, P., et al. (2017). Guidelines for the prevention and treatment of travelers’ diarrhea: a graded expert panel report. Journal of Travel Medicine, Vol 24, Suppl 1, S63-S80. doi: 1093/jtm/tax026