Prevention with Medication

There have been several studies demonstrating that antimicrobials taken daily during a trip are highly protective (Winstrom et al, 1987). The first studies, done about 30 years ago, showed doxycycline to be highly effective; however, because many bacteria, including E.coli, now are resistant to doxycycline this drug is no longer used for that purpose. At present, Ciprofloxacin (Cipro) or other fluoroquinolones are the drugs of choice. They will prevent about 90% of expected episodes. If used for this purpose, they are taken once a day, beginning 1 day before travel, each day on the trip, and 1 day after leaving. In general these are not

TABLE 50-2. Prevention and Treatment of Travelers' Diarrhea

Prevention of Travelers' Diarrhea Food and Water Precautions—riskiest foods are fresh vegetable salads and untreated water

Antimicrobials (optional, see text)—Fluroquinolones can be used od, beginning 1 day before travel, and continuing to 1 day after travel. This regimen can be used safely for at least 3 weeks. This provides about 90% protection against developing travelers' diarrhea. Other agents—Bismuth subsalicylate, given qid, has been found to prevent about 60% of travelers' diarrhea. It should not be taken with antibiotics.

Treatment of Travelers' Diarrhea

Hydration

Increase oral intake of fluids containing carbohydrates and salt to prevent/treat dehydration. Packets of oral rehydratrion solution are ideal for this purpose. IV replacement of fluids may be necessary in severe cases. Antibiotics*

Ciprofloxacin (or other fluoroquinolones) bid for 1 to 2 days Or Azithromycin (for children or adults) daily for 1 to 2 days Or Rifaxamin bid or tid for 3 days Symptomatic treatment

Loperamide—Imodium-like drug can be used after antibiotic started to decrease frequency of bowel movements.

Adapted from Sack, 1990; Ansdell and Ericsson, 1999. bid = twice daily; od = once daily; qid = four times daily.

*Doxycycline and trimethoprim-sulfamethoxazol are no longer drugs of choice because of the high degree of bacterial resistance to these antimicrobials.

used for longer than 3 weeks at a time. Pepto-Bismol has also been used on a four times daily basis and can prevent approximately 60% of episodes. (Although the mechanism of action is not clearly understood, Pepto-Bismol has been found to have both some antibacterial and antitoxic activity.) The disadvantage of taking a medication four times daily during travel mitigates against its frequent use.

Who would benefit from prophylaxis? Only certain travelers are usually thought to be good candidates for drug prophylaxis, such as those who have scheduled appointments that cannot be missed, including musicians on concert tours or lecturers at important meetings. Other categories would include travelers with medical illnesses that could be significantly worsened by an episode of travelers' diarrhea. For most travelers, providing self-treatment is adequate (discussed below). The possible drawbacks of using this type of preventive therapy are the possibility of allergic reactions and the theoretical possibility of facilitating the emergence of antibiotic resistant enteric organisms. This latter concern, however, seems unimportant, because in most developing countries antibiotics are freely available without a prescription and are used widely by the population.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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