Travelers’ Diarrhea — Its Prevention and Treatment

Summary

Diarrhea continues to be an important problem among persons traveling from low-risk regions to developing areas where enteric infection is hyperendemic in the local population. Persons traveling to these areas should be knowledgeable about how to treat the illness should it occur. For mild to moderate illness (less than six unformed stools per 24 h without disabling cramps and pain) bismuth subsalicylate (4.2 g taken over 4–8 h to be repeated a 2nd day) can be used or loperamide 4 mg initially followed by 2 mg after each unformed bowel movement (not to exceed 8–16 mg/day for 48 h). For severe illness (≧ six unformed stools/24 h, when cramps or pain are severe or when there is fever or bloody stools), trimethoprim/sulfamethoxazole (TMP/SMX) can be taken in a dose of 160 mg TMP/800 SMX twice daily for 3 days. Although not entirely effective, exercising care in where and what one eats and drinks is the most practical means of reducing the frequency of illness. Certain preventive medicines are available and effective when taken daily (TMP/SMX and doxycycline). A Consensus Development panel in the United States advised against taking these drugs in this way unless special health problems exist. Recently, the solid form of bismuth subsalicylate was found to be 65% effective in preventing travelers’diarrhea when taken in a dose of 2.1 g/day as two tablets four times a day (with meals and at bedtime). Research is currently being undertaken to develop passive and active immunizing agents against the major cause of illness, enterotoxigenic Escherichia coli.

The Studies reported herein were supported by the National Institutes of Health(NIAID) (NO1-AI 72534 and RO1-AI 23049), by the Environmental Protection Agency (Cr-809331) and by various pharmaceutical sponsors (Norwich Eaton Pharmaceuticals, Burroughs Wellcome Company, Procter and Gamble Co., Miles Pharmaceuticals, Inc.) Ms. Dot Cowan was responsible for word processing.