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Traveler's diarrhea

Key sources
The following summarized guidelines for the evaluation and management of traveler's diarrhea are prepared by our editorial team based on guidelines from the International Society of Travel Medicine (ISTM 2017), the Infectious Diseases Society of America (IDSA 2017), and the American College of Gastroenterology (ACG 2016).
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Guidelines

1.Classification and risk stratification

Severity grading: recognize the definitions of severity of traveler's diarrhea:
Situation
Guidance
Mild (acute)
Diarrhea that is tolerable, is not distressing, and does not interfere with planned activities
Moderate (acute)
Diarrhea that is distressing or interferes with planned activities
Severe (acute)
Diarrhea that is incapacitating or completely prevents planned activities
All dysentery (passage of grossly bloody stools) is considered severe
Persistent
Diarrhea lasting ≥ 2 weeks
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2.Diagnostic investigations

Microbiologic testing: as per IDSA 2017 guidelines, do not obtain diagnostic testing in most patients with uncomplicated traveler's diarrhea, unless treatment is indicated.
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More topics in this section

  • Molecular testing

  • Evaluation for parasites

  • Evaluation for other causes

3.Medical management

Antibiotics, indications: do not initiate antibiotic treatment in patients with mild traveler's diarrhea.
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  • Antibiotics (choice of agent)

  • Loperamide

  • Bismuth subsalicylate

  • Probiotics

4.Patient education

Pretravel counseling: provide pretravel counseling including information about the risk of acquisition of multidrug-resistant bacteria, balanced against the benefits of antibiotic use.

5.Preventative measures

Chemoprophylaxis, indications
Do not administer routine antimicrobial prophylaxis in travelers.
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Consider administering antimicrobial prophylaxis in travelers at high risk of health-related complications of traveler's diarrhea.
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More topics in this section

  • Chemoprophylaxis (choice of agent)

  • Probiotics