Review article: prevention and treatment of travellers' diarrhoea

Travellers' diarrhoea is a common problem worldwide and is likely to continue to increase with the expansion of foreign travel. ETEC is the most frequently isolated enteropathogen although other bacteria, parasites and viruses may be important, depending on the geographic location. New pathogens may well emerge in the future. Prevention must be the ultimate goal but while awaiting effective vaccines we must be content with the traditional dietary advice and its often unpalatable and unacceptable restrictions. Antibiotic prophylaxis is clearly effective but for the present should be restricted to high risk individuals and in those in whom any disruption of a short stay would be critical. For those taking antibiotic prophylaxis advice, as always, should be given regarding the possible adverse effects. Concern about the emergence of resistant strains may be less with the new 4-fluoroquinolone antibiotics. Alternatives for prophylaxis include bismuth subsalicylate which is safe and not an environmental hazard. We must await developments in the Lactobacillus sp. story to see whether the use of probiotics have any role in the prevention of travellers' diarrhoea. Antimotility agents have no place in prophylaxis. The cornerstone of treatment of travellers' diarrhoea is the maintenance of fluid and electrolyte balance. It is particularly important in infants and young children and should be given in the form of oral glucose-electrolyte solutions of which there are many effective preparations. A variety of antibiotics are now known to reduce the duration of travellers' diarrhoea but there is still concern about the risk of therapy for what is usually a minor illness of inconvenience. However, when the loss of 1 or 2 days during a short visit is critical, one could opt for a short course of antibiotics (trimethoprim-sulphamethoxazole, or a 4-fluoroquinolone for 3 days or less) in combination with an antidiarrhoeal trimethoprim alone agent such as loperamide.