Traveler's diarrhea medical therapy

Jump to navigation Jump to search

Traveler's diarrhea Microchapters

Home

Patient Information

Overview

Classification

Pathophysiology

Causes

Differentiating Traveler's Diarrhea from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Traveler's diarrhea medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Traveler's diarrhea medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Traveler's diarrhea medical therapy

CDC on Traveler's diarrhea medical therapy

Traveler's diarrhea medical therapy in the news

Blogs on Traveler's diarrhea medical therapy

Directions to Hospitals Treating Traveler's diarrhea

Risk calculators and risk factors for Traveler's diarrhea medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The mainstay of therapy for traveler's diarrhea is rehydration and antimicrobial therapy. Since the majority of cases of traveler's diarrhea are caused by bacterial pathogens, empiric antibiotic therapy is usually recommended among both adult and pediatric patients diagnosed with traveler's diarrhea. Travelers who develop three or more loose stools in a 24-hour period — especially if associated with nausea, vomiting, abdominal cramps, fever, or blood in stools — benefit from antimicrobial therapy. Antibiotics usually are given for 3–5 days, but single dose or 1-3 day regimen are also effective among adults and children. Antimicrobial monotherapy typically includes oral administration of either levofloxacin 500 mg qd, norfloxacin 400 mg bid, ciprofloxacin 500 mg bid, Ofloxacin 200 mg bid, or azithromycin 500 mg qd (3-5 days) or 1000 mg (single dose). Symptomatic management of abdominal cramps and vomiting may also be required.

Medical Therapy

  • The mainstay of therapy for traveler's diarrhea is rehydration and antimicrobial therapy.[1]

Rehydration

  • Oral rehydration fluids are indicated among patients who can tolerate oral intake, otherwise IV rehydration is indicated.[1]
  • Over the counter oral rehydration solutions (ORS) are optimal options for oral rehydration and are usually available for both adults and children.
  • Oral rehydration solutions may be home-made by mixing the following:[1]
  • Drinking water: 1 liter
  • Salt: 0.5 teaspoon
  • Sugar: 6 teaspoons
  • Rehydration must be gradual until signs of dehydration (e.g. dry mouth, oliguria) are resolved. Drinking ORS must be slow (1 sip every 5 minutes).[1]
  • Children often require 1 liter of ORS, whereas adults often require 3 liters of ORS.
  • Energy drinks with high concentrations of electrolytes (e.g. sports drinks) may be offered to adults, but not children.
  • Fluids high in sugar content (e.g. soda) are not recommended because they may worsen the dehydration.[1]

Antimicrobial Therapy

  • Since the majority of cases of traveler's diarrhea are caused by bacterial pathogens, empiric antibiotic therapy is usually recommended among both adult and pediatric patients diagnosed with traveler's diarrhea.[1]
  • Travelers who develop three or more loose stools in a 24-hour period — especially if associated with nausea, vomiting, abdominal cramps, fever, or blood in stools — benefit from antimicrobial therapy.
  • Antibiotics usually are given for 3–5 days, but single dose azithromycin or levofloxacin have been used (for adults and children).[2]
  • If diarrhea persists despite therapy, travelers should be evaluated and treated for possible parasitic infection.
  • Antibiotic treatment
  • Preferred regimen (1): Norfloxacin 400 mg PO bid single dose or 1-3 day therapy
  • Preferred regimen (2): Ciprofloxacin 500 mg PO bid single dose or 1-3 day therapy
  • Preferred regimen (3): Ofloxacin 200 mg PO bid single dose or 1-3 day therapy
  • Preferred regimen (4): Levofloxacin 500 mg PO qd single dose or 1-3 day therapy
  • Alternative regimen (1): Azithromycin 1000 mg PO single dose OR Azithromycin 500 mg PO qd for 1-3 days

Symptomatic Management

  • Abdominal discomfort
  • Vomiting
  • Preferred regimen (2): Loperamide 4 mg PO THEN 2 mg after each loose stool not to exceed 16 mg daily
  • Note (1): Antimotility agents are not generally recommended for patients with bloody diarrhea or those who have diarrhea and fever.
  • Note (2): Loperamide can be used in children, and liquid formulations are available. In practice, however, these drugs are rarely given to small children (aged <6 years)

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Connor, Bradley A. (2015). "Traveler's Diarrhea". www.cdc.gov. Centers for Disease Control and Prevention. Retrieved March 1, 2016.
  2. Sanders JW, Frenck RW, Putnam SD; et al. (2007). "Azithromycin and loperamide are comparable to levofloxacin and loperamide for the treatment of traveler's diarrhea in United States military personnel in Turkey". Clin Infect Dis. 45: 294&ndash, 301.
  3. 3.0 3.1 "The Practice of Travel Medicine: Guidelines by the Infectious Diseases Society of America" (PDF).

Template:WikiDoc Sources