Travelers' diarrhea. Controversy and consensus

In view of all the controversy surrounding travelers' diarrhea, how should patients be counseled regarding its prevention and treatment? First, all patients should be instructed on the importance of eating and drinking only safe food and water and on methods of dietary manipulation and oral rehydration therapy. The travelers listed in table 4, as well as short-term visitors to Mexico, may be candidates for prophylactic medication unless such treatment is contraindicated. All patients can be offered an antimotility agent for discriminant use as discussed, and a prescription for trimethoprim-sulfamethoxazole is generally a good idea in the event of a severe bout of illness during travel. A traveler can go overboard in an attempt to avoid diarrheal illness. Such overconcern can detract from the enjoyment of travel and limit the spectrum of activities and cuisine. One report noted that diarrhea seemed to occur more frequently the more a traveler tried to elude it! This could well set the stage for the biggest controversy of all.