Advertisement

Travellers’ Diarrhoea

  • Joseph Torresi
  • Sarah McGuinness
  • Karin Leder
  • Daniel O’Brien
  • Tilman Ruff
  • Mike Starr
  • Katherine Gibney
Chapter
  • 219 Downloads

Abstract

Travellers’ diarrhoea (TD) is the most common illness of travellers to developing countries. In this chapter, we review the travel destinations with the highest incidence of TD, describe the main aetiologies and discuss the issues surrounding prevention and management of TD in some detail. We include discussion of current controversies regarding when self-treatment of TD with antibiotics should be advised. Chemoprophylaxis is rarely recommended, but we outline situations for which it may be considered. We also include a brief overview of management of diarrhoea in the returned traveller.

Key Reading

  1. Allen SJ, Martinez EG, Gregorio GV, Dans LF. Probiotics for treating acute infectious diarrhoea. Cochrane Database Syst Rev. 2010;(11):CD003048.Google Scholar
  2. Arcilla MS, van Hattem JM, Haverkate MR, Bootsma MC, van Genderen PJ, Goorhuis A, et al. Import and spread of extended-spectrum β-lactamase-producing Enterobacteriaceae by international travellers (COMBAT study): a prospective, multicentre cohort study. Lancet Infect Dis. 2017;17:78–85.CrossRefGoogle Scholar
  3. Barrett J, Brown M. Travellers’ diarrhoea. BMJ. 2016;353:i1937.CrossRefGoogle Scholar
  4. Briand V, Buffet P, Genty S, et al. Absence of efficacy of nonviable Lactobacillus acidophilus for the prevention of traveler’s diarrhea: a randomized, double-blind, controlled study. Clin Infect Dis. 2006;43(9):1170–5.CrossRefGoogle Scholar
  5. Connor B, Torresi J. Empiric management of acute TD abroad and in the recently returned traveler. In: Ericsson CD, DuPont HL, Steffen R, editors. Travellers diarrhoea. 2nd ed. Hamilton: BC Becker Inc.; 2007.Google Scholar
  6. Diemert DJ. Prevention and self-treatment of traveler’s diarrhea. Clin Microbiol Rev. 2006;19(3):583–94.CrossRefGoogle Scholar
  7. DuPont HL, Ericsson CD, Farthing MJ, Gorbach S, Pickering LK, Rombo L, et al. Expert review of the evidence base for prevention of travelers’ diarrhea. J Travel Med. 2009;16(3):149–60.CrossRefGoogle Scholar
  8. DuPont HL. Persistent diarrhea: a clinical review. JAMA. 2016;315(24):2712–23.CrossRefGoogle Scholar
  9. Ferrah N, Leder K, Gibney K. Review of the causes and management of chronic gastrointestinal symptoms in returned travellers referred to an Australian infectious diseases service. Aust Fam Physician. 2016;45(5):333–9.PubMedGoogle Scholar
  10. Freedman DO, Weld LD, Kozarsky PE, Tamara Fisk T, et al. Spectrum of disease and relationship to place of exposure in ill returned travelers. N Engl J Med. 2006;354:119–30.CrossRefGoogle Scholar
  11. Greenwood Z, Black J, Weld L, O’Brien D, Leder K, Von Sonnenburg F, et al. Gastrointestinal infection among international travelers globally. J Travel Med. 2008;15(4):221–8.CrossRefGoogle Scholar
  12. Hu Y, Ren J, Zhan M, Li W, Dai H. Efficacy of rifaximin in prevention of travelers’ diarrhea: a meta-analysis of randomized, double-blind, placebo-controlled trials. J Travel Med. 2012;19(6):352–6.CrossRefGoogle Scholar
  13. Jiang ZD, DuPont HL. Etiology of travellers’ diarrhea. J Travel Med. 2017;24(Suppl_1):S13–6.CrossRefGoogle Scholar
  14. Kantele A, Lääveri T, Mero S, et al. Antimicrobials increase travelers’ risk of colonization by extended-spectrum betalactamase-producing Enterobacteriaceae. Clin Infect Dis. 2015;60(6):837–46.CrossRefGoogle Scholar
  15. Kantele A, Mero S, Kirveskari J, Lääveri T. Increased risk for ESBL-producing bacteria from co-administration of loperamide and antimicrobial drugs for travelers’ diarrhea. Emerg Infect Dis. 2016;22(1):117–20.CrossRefGoogle Scholar
  16. Leder K. Advising travellers about management of travellers’ diarrhoea. Aust Fam Physician. 2015;44(1–2):34–7.PubMedGoogle Scholar
  17. McFarland LV. Meta-analysis of probiotics for the prevention of traveler’s diarrhea. Travel Med Infect Dis. 2007;5:97–105.CrossRefGoogle Scholar
  18. Murray CK, Blyth MDM. Acquisition of multidrug-resistant gram-negative organisms during travel. Mil Med. 2017;182(9–10):26–33.CrossRefGoogle Scholar
  19. Nair D. Travelers’ diarrhea: prevention, treatment, and post-trip evaluation. J Fam Pract. 2013;62(7):356–61.PubMedGoogle Scholar
  20. Ng QX, Ho CYX, Shin D, Venkatanarayanan N, Chan HW. A meta-analysis of the use of rifaximin to prevent travellers’ diarrhoea. J Travel Med. 2017; 24(5).Google Scholar
  21. Pham M, Lemberg DA, Day AS. Probiotics: sorting the evidence from the myths. Med J Aust. 2008;188(5):304–8.CrossRefGoogle Scholar
  22. Riddle MS, Arnold S, Tribble DR. Effect of adjunctive loperamide in combination with antibiotics on treatment outcomes in traveler’s diarrhea: a systematic review and meta-analysis. Clin Infect Dis. 2008;47(8):1007–14.CrossRefGoogle Scholar
  23. Riddle MS, DuPont HL, Connor BA. ACG clinical guideline: diagnosis, treatment, and prevention of acute diarrheal infections in adults. Am J Gastroenterol. 2016;111(5):602–22.CrossRefGoogle Scholar
  24. Riddle MS, Connor BA, Beeching NJ, DuPont HL, Hamer DH, Kozarsky P, Libman M, Steffen R, Taylor D, Tribble DR, Vila J, Zanger P, Ericsson CD. Guidelines for the prevention and treatment of travelers’ diarrhea: a graded expert panel report. J Travel Med. 2017;24(Suppl_1):S57–74.CrossRefGoogle Scholar
  25. Shlim DR. Looking for evidence that personal hygiene precautions prevent traveler’s diarrhea. Clin Infect Dis. 2005;41(Suppl 8):S531–5.CrossRefGoogle Scholar
  26. Steffen R, Hill DR, DuPont HL. Traveler’s diarrhea: a clinical review. JAMA. 2015;313(1):71–80.CrossRefGoogle Scholar
  27. Steffen R. Epidemiology of travellers’ diarrhea. J Travel Med. 2017;24(Suppl_1):S2–5.CrossRefGoogle Scholar
  28. Swaminathan A, Torresi J, Schlagenhauf P, Thursky K, et al. for the GeoSentinel Surveillance Network. Pathogens and host risk factors associated with infectious gastrointestinal disease in returned international travelers. J Infect. 2009;59:19–27.CrossRefGoogle Scholar
  29. Tribble DR, Sanders JW, Pang LW, Mason C, et al. Traveler’s diarrhea in Thailand: randomized, double-blind trial comparing single-dose and 3-day azithromycin- based regimens with a 3-day levofloxacin regimen. Clin Infect Dis. 2007;44:338–46.CrossRefGoogle Scholar
  30. Tribble DR. Antibiotic therapy for acute water diarrhea and dysentery. Mil Med. 2017;182(S2):17–25.CrossRefGoogle Scholar
  31. Wingate D, Phillips SF, Lewis SJ, et al. Guidelines for adults on self-medication for the treatment of acute diarrhea. Aliment Pharmacol Ther. 2001;15(6):773–82.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Joseph Torresi
    • 1
    • 2
    • 3
    • 4
  • Sarah McGuinness
    • 5
    • 6
  • Karin Leder
    • 7
    • 8
  • Daniel O’Brien
    • 9
    • 10
  • Tilman Ruff
    • 11
    • 12
  • Mike Starr
    • 13
  • Katherine Gibney
    • 14
  1. 1.Professor of Medicine, Infectious Diseases Physician University of Melbourne, Department of Microbiology and ImmunologyThe Peter Doherty Institute for Infection and Immunity, The University of MelbourneMelbourneAustralia
  2. 2.Knox Private HospitalMelbourneAustralia
  3. 3.Epworth Eastern HospitalMelbourneAustralia
  4. 4.Austin HospitalMelbourneAustralia
  5. 5.Infectious Diseases Physician, Department of Infectious DiseasesThe Alfred Hospital and Monash UniversityMelbourneAustralia
  6. 6.Lecturer, Infectious Disease Epidemiology UnitSchool of Public Health and Preventive Medicine, Monash UniversityMelbourneAustralia
  7. 7.Professor of Medicine, Infectious Diseases Physician, Head of Infectious Disease EpidemiologySchool of Public Health and Preventive Medicine, Monash UniversityMelbourneAustralia
  8. 8.Head of Travel Medicine and Immigrant Health, Victorian Infectious Disease ServiceRoyal Melbourne Hospital Peter Doherty, Institute for Infection and ImmunityMelbourneAustralia
  9. 9.Associate Professor, Victorian Infectious Diseases ServiceRoyal Melbourne HospitalMelbourneAustralia
  10. 10.Department of Infectious DiseasesUniversity Hospital GeelongGeelongAustralia
  11. 11.Associate Professor, Nossal Institute for Global HealthSchool of Population and Global Health, The University of MelbourneMelbourneAustralia
  12. 12.International Medical Advisor, Australian Red Cross (1996–2019)Founding Head of Travel Medicine at Fairfield and Royal Melbourne HospitalsMelbourneAustralia
  13. 13.Paediatrician, Infectious Diseases Physician, Consultant in Emergency Medicine, Director of Paediatric Education, Royal Children’s Hospital Melbourne, Honorary Clinical Associate Professor, University of MelbourneMelbourneAustralia
  14. 14.Infectious Diseases Physician, Public Health Physician and Senior Research FellowThe Austin Hospital, The Royal Melbourne Hospital, and The University of Melbourne, at The Peter Doherty Institute for Infection and ImmunityMelbourneAustralia

Personalised recommendations