Systematic review: prevention of travellers' diarrhoea

Renewed interest in the use of antibiotics to prevent travellers' diarrhoea has occurred with the availability of non-absorbed (<0.4%) rifaximin, and with evidence that a subgroup of travellers with diarrhoea have progression of their illnesses to postinfectious irritable bowel syndrome.

To summarize recently published information and make recommendations on travellers' diarrhoea prevention.

PubMed was reviewed on 2 January 2008 for 255 articles on the topic of 'travellers diarrhoea' published beginning with 2000 along with the author's extensive file on prevention of travellers' diarrhoea.

Exercising care in food and beverage selection, while of unproven value, is recommended during travel to high-risk areas of Latin America, Southern Asia or Africa. An algorithm is presented to identify future travellers, for which chemoprophylaxis is appropriate. The preferred drug for prevention of travellers' diarrhoea is rifaximin, with bismuth subsalicylate or a fluoroquinolone also being effective. Vaccines against the principal cause of travellers' diarrhoea, enterotoxigenic Escherichia coli, are being developed.

Research is needed to determine the relative effectiveness of exercising care on food and beverage selection and chemoprophylaxis in preventing travellers' diarrhoea and postinfectious irritable bowel syndrome during high-risk travel. Enterotoxigenic E. coli vaccines appear to be a promising addition to travel medicine.