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J Travel Med. 2017 Apr 1;24(suppl_1):S57-S74. doi: 10.1093/jtm/tax026.

Guidelines for the prevention and treatment of travelers' diarrhea: a graded expert panel report.

Author information

1
Naval Medical Research Center, Silver Spring, MD, USA.
2
Weill Cornell Medical College and The New York Center for Travel and Tropical Medicine, New York, NY, USA.
3
Clinical Science Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, UK and National Institute of Health Research (NIHR) Health Protection Unit in Gastrointestinal Infections, Farr Institute, University of Liverpool, Liverpool, UK.
4
University of Texas School of Public Health, Houston, TX, USA.
5
Department of Global Health, Center for Global Health and Development, Boston University School of Public Health, Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
6
Emory University, Atlanta, GA, USA.
7
J.D. MacLean Centre for Tropical Diseases, McGill University, Montreal, Québec, Canada.
8
Epidemiology, Biostatistics and Prevention Institute, World Health Organization Collaborating Centre for Traveller's Health, University of Zurich, Zurich, Switzerland.
9
PATH, Seattle, WA, USA.
10
Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
11
ISGlobal, Barcelona Centre for International Health Research, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain.
12
Institute of Public Health, University Hospitals, Ruprecht-Karls-Universität, Heidelberg, Germany.
13
Department of Medicine, Division of Infectious Diseases, University of Texas Medical School at Houston, Houston, TX, USA.

Abstract

Background:

: Travelers' diarrhea causes significant morbidity including some sequelae, lost travel time and opportunity cost to both travelers and countries receiving travelers. Effective prevention and treatment are needed to reduce these negative impacts.

Methods:

: This critical appraisal of the literature and expert consensus guideline development effort asked several key questions related to antibiotic and non-antibiotic prophylaxis and treatment, utility of available diagnostics, impact of multi-drug resistant (MDR) colonization associated with travel and travelers' diarrhea, and how our understanding of the gastrointestinal microbiome should influence current practice and future research. Studies related to these key clinical areas were assessed for relevance and quality. Based on this critical appraisal, guidelines were developed and voted on using current standards for clinical guideline development methodology.

Results:

: New definitions for severity of travelers' diarrhea were developed. A total of 20 graded recommendations on the topics of prophylaxis, diagnosis, therapy and follow-up were developed. In addition, three non-graded consensus-based statements were adopted.

Conclusions:

: Prevention and treatment of travelers' diarrhea requires action at the provider, traveler and research community levels. Strong evidence supports the effectiveness of antimicrobial therapy in most cases of moderate to severe travelers' diarrhea, while either increasing intake of fluids only or loperamide or bismuth subsalicylate may suffice for most cases of mild diarrhea. Further studies are needed to address knowledge gaps regarding optimal therapies, the individual, community and global health risks of MDR acquisition, manipulation of the microbiome in prevention and treatment and the utility of laboratory testing in returning travelers with persistent diarrhea.

KEYWORDS:

Clinical practice guideline; emporiatrics; evidence-based medicine

PMID:
28521004
PMCID:
PMC5731448
DOI:
10.1093/jtm/tax026
[Indexed for MEDLINE]
Free PMC Article

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