Traveler's diarrhea: Difference between revisions
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# if diarrhea starts >1 mo after travel- not caused by travel
# if diarrhea starts >1 mo after travel- not caused by travel


==Treatment<ref>Sanford 2014</ref>==
==Treatment==
*Antibiotic
===Antibiotics===
**[[Ciprofloxacin]] 750mg PO BID x 1-3 days OR
{{Travelers Diarrhea Antibiotics}}
**[[Levofloxacin]] 500mg PO q24h x 1-3 days OR
**[[Ofloxacin]] 300mg PO BID x 3 days OR
**[[Rifaximin]] 200mg PO TID x 3 days OR
**[[Azithromycin]] 1000mg PO x 1 OR 500mg PO q24h x 3 days
*Antimotility agent
**Only for nonpregnant adults with no fever or blood in stool
**[[Loperamide]] 4mg PO after each loose stool (Max: 16mg/day)


===Pediatrics<ref>Sanford 2014</ref>===
===Antimotility agent===
*[[Azithromycin]] 10mg/kg/day once daily x 3 days OR
*Only for nonpregnant adults with no fever or blood in stool
*[[Ceftriaxone]] 50mg/kg/day once daily x 3 days
*[[Loperamide]] 4mg PO after each loose stool (Max: 16mg/day)
*Avoid [[fluroquinolones]]
 
===Pediatrics===
'''Antibiotic Options:'''
{{Travelers Diarrhea Pediatric Antibiotics}}


==See Also==
==See Also==

Revision as of 21:45, 2 September 2014

Background

  • Most respond to antibiotics
  • as duration of diarrhea increases, higher chance of parasitic cause

Differential Diagnosis

Traveler's

  1. Giardia
  2. Cryptosporidiosis
  3. Entamoeba histolytica
  4. Cyclospora

Acute diarrhea

Infectious

Noninfectious

Watery Diarrhea

Traveler's Diarrhea

Diagnosis

  1. dysentery if stool bloody, fvr or wbc in stool- invasive inflamm enteropathy
  2. has abrupt onset, metastatic lesions, reactive arthopathies, or campylobacter assoc guillain barre- maybe flouroquinolone resis esp in SE Asia
  3. amoebic dysentery insidious and can get amoebic liver abscess
  4. if do not find infc cause of dysentery, eval pt for IBD or CA
  5. prolonged diarrhea and malabsorption- giardia or tropical sprue- does not respond to removal of gluten from diet- tx with tetra and folate
  6. also consider postinfectious disaccharidase deficiency or irritable bowel dz
  7. if diarrhea starts >1 mo after travel- not caused by travel

Treatment

Antibiotics

  • Ciprofloxacin 750mg PO once daily x 1-3 days[2]
    • First choice for use except in South and Southeast Asia[3]
  • Azithromycin 500mg PO q24h x 3 days OR 1000mg PO x 1[4]
    • Nausea is a frequent adverse event[5]
    • First choice for use in South and Southeast Asia[6]
  • Rifaximin 200mg PO TID x 3 days[7]

Antimotility agent

  • Only for nonpregnant adults with no fever or blood in stool
  • Loperamide 4mg PO after each loose stool (Max: 16mg/day)

Pediatrics

Antibiotic Options:

Avoid fluroquinolones

See Also

Source

  1. ↑ Marx et al. “Cholera and Gastroenteritis caused by Noncholera Vibrio Species”. Rosen’s Emergency Medicine 8th edition vol 1 pg 1245-1246.
  2. ↑ Hoge CW. et al. Trends in antibiotic resistance among diarrheal pathogens isolated in Thailand over 15 years. Clin Infect Dis. 1998;26:341–5
  3. ↑ Steffen R, et al. Traveler’s Diarrhea: A Clinical Review. JAMA. 2015;313(1):71-80. doi:10.1001/jama.2014.17006
  4. ↑ Sanders JW. et al. An observational clinic-based study of diarrheal illness in deployed United States military personnel in Thailand: presentation and outcome of Campylobacter infection. Am J Trop Med Hyg. 2002;67:533–8
  5. ↑ Steffen R, et al. Traveler’s Diarrhea: A Clinical Review. JAMA. 2015;313(1):71-80. doi:10.1001/jama.2014.17006
  6. ↑ Steffen R, et al. Traveler’s Diarrhea: A Clinical Review. JAMA. 2015;313(1):71-80. doi:10.1001/jama.2014.17006
  7. ↑ DuPont HL. et al. Rifaximin versus ciprofloxacin for the treatment of traveler’s diarrhea: a randomized, double-blind clinical trial. Clin Infect Dis. 2001;33:1807–15
  8. ↑ Stauffer WM, Konop RJ, Kamat D. Traveling with infants and young children. Part III: travelers’ diarrhea. J Travel Med. 2002;9:141–50
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