Traveler's diarrhea

Background

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

DDx

1. See DDx Diarrhea
2. Giardia
3. Cryptosporidiosis
4. Entamoeba
5. Cyclospora

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

• Antibiotic
  • Ciprofloxacin 750mg PO BID x 1-3 days OR
  • 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

• Azithromycin 10mg/kg/day once daily x 3 days OR
• Ceftriaxone 50mg/kg/day once daily x 3 days
• Avoid fluroquinolones

See Also

• Diarrhea
• Diarrhea (Peds)
• Travel Medicine