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Guidelines for the prevention and treatment of travelers' diarrhea: a graded expert panel report.

Riddle, Mark S, Connor, Bradley A, Beeching, Nicholas ORCID: https://orcid.org/0000-0002-7019-8791, DuPont, Herbert L, Hamer, Davidson H, Kozarsky, Phyllis, Libman, Michael, Steffen, Robert, Taylor, David, Tribble, David R, Vila, Jordi, Zanger, Philipp and Ericsson, Charles D (2017) 'Guidelines for the prevention and treatment of travelers' diarrhea: a graded expert panel report.'. Journal of Travel Medicine, Vol 24, Issue suppl_1, S57-S74.

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Abstract

Background
: Travelers' diarrhea causes significant morbidity including some sequelae, lost travel time and opportunity cost to both travelers and countries receiving travelers. Effective prevention and treatment are needed to reduce these negative impacts.

Methods
: This critical appraisal of the literature and expert consensus guideline development effort asked several key questions related to antibiotic and non-antibiotic prophylaxis and treatment, utility of available diagnostics, impact of multi-drug resistant (MDR) colonization associated with travel and travelers' diarrhea, and how our understanding of the gastrointestinal microbiome should influence current practice and future research. Studies related to these key clinical areas were assessed for relevance and quality. Based on this critical appraisal, guidelines were developed and voted on using current standards for clinical guideline development methodology.

Results
: New definitions for severity of travelers' diarrhea were developed. A total of 20 graded recommendations on the topics of prophylaxis, diagnosis, therapy and follow-up were developed. In addition, three non-graded consensus-based statements were adopted.

Conclusions
: Prevention and treatment of travelers' diarrhea requires action at the provider, traveler and research community levels. Strong evidence supports the effectiveness of antimicrobial therapy in most cases of moderate to severe travelers' diarrhea, while either increasing intake of fluids only or loperamide or bismuth subsalicylate may suffice for most cases of mild diarrhea. Further studies are needed to address knowledge gaps regarding optimal therapies, the individual, community and global health risks of MDR acquisition, manipulation of the microbiome in prevention and treatment and the utility of laboratory testing in returning travelers with persistent diarrhea.

Item Type: Article
Subjects: WA Public Health > Preventive Medicine > WA 108 Preventive health services. Preventive medicine. Travel Medicine.
WB Practice of Medicine > Therapeutics > WB 330 Drug therapy
WI Digestive System > WI 407 Diarrhea
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1093/jtm/tax026
Depositing User: Stacy Murtagh
Date Deposited: 27 Apr 2018 14:43
Last Modified: 27 Apr 2018 14:43
URI: http://archive.lstmed.ac.uk/id/eprint/8543

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