[Management of patients with traveler's diarrhea]

Traveler's diarrhea starts 5 to 15 days after arrival with 3 or more watery bowel movements daily in 4 to more than 50% of travelers depending on geographical regions. Enterotoxin producing strains of E. coli are isolated in 20 to 50% of patients, followed by shigella, salmonella, campylobacter and vibrio spp. Rarely giardia lamblia, entamoeba histolytica and cryptosporidia are causative organisms. The cornerstone of treatment is oral rehydration. The efficacy of anti-diarrhetics is not convincingly proved and as to loperamid this drug may prolong invasive forms of diarrhea. Antibiotics are indicated if leucocytes or blood are found in stool. Cotrimoxazole and aminopenicillins are loosing efficacy because of growing resistance. The minimal. In a double blind placebo controlled trial with 500 mg ciprofloxacin b.i.d. for 5 days we were able to demonstrate a significant clinical and bacteriologic effect in 132 patients with salmonellosis and campylobacteriosis.