Travellers diarrhoea - Management of Infection Guidance for Primary Care

Publication: 30/09/2010  
Last review: 09/02/2016  
Next review: 05/12/2020  
Clinical Guideline
CURRENT 
ID: 2252 
Approved By:  
Copyright© Leeds Teaching Hospitals NHS Trust 2016  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Traveller’s Diarrhoea

Illness

Comments

Traveller’s diarrhoea
CKS

Only consider standby antibiotics for remote areas or people at high-risk of severe Illness with travellers’ diarrhoea 1, 2C
If standby antibiotics appropriate: seek advice from travel clinic  (private Rx)

Principles of Treatment

  1. This guidance is based on the best available evidence but its application must be modified by professional judgement.
  2. Where a ‘best guess’ therapy has failed or special circumstances exist, microbiological advice can be obtained from LTHT Microbiology (Mon-Fri 9am-5pm and Sat and Sun 9am-1pm: 0113 39 23962/28580; Otherwise via LTHT switchboard - ask for the On call Microbiology Registrar)

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Provenance

Record: 2252
Objective:
  • to provide a simple, empirical approach to the treatment of common infections
  • to promote the safe, effective and economic use of antibiotics
  • to minimise the emergence of bacterial resistance and reduce the incidence of Healthcare Associated Infections in the community
Clinical condition:

Travellers diarrhoea

Target patient group:
Target professional group(s): Primary Care Doctors
Pharmacists
Adapted from:

This guidance was initially developed in 1999 by practitioners in South Devon, as part of the S&W Devon Joint Formulary Initiative, and Cheltenham & Tewkesbury Prescribing Group and modified by the PHLS South West Antibiotic Guidelines Project Team, PHLS Primary Care Co-ordinators and members of the Clinical Prescribing Sub-group of the Standing Medical Advisory Committee on Antibiotic Resistance. It was further modified following comments from Internet users. The guidance has been updated annually as significant research papers, systematic reviews and guidance have been published. The Health Protection Agency works closely with the authors of the Clinical Knowledge Summaries.


Evidence base

Grading of guidance recommendations

The strength of each recommendation is qualified by a letter in parenthesis.

Study design

Recommendation grade

Good recent systematic review of studies

A+

One or more rigorous studies, not combined

A-

One or more prospective studies

B+

One or more retrospective studies

B-

Formal combination of expert opinion

C

Informal opinion, other information

D

Letters indicate strength of evidence:
A+ = systematic review: D = informal opinion

Traveller’s diarrhoea

1. Dupont HL. Systematic review: prevention of travellers’ diarrhoea. Aliment Pharmacol Ther 2008;27:741-51. RATIONALE: Expert opinion is that people travelling to a high-risk area whose condition could be worsened by a bout of diarrhoea may be considered for standby antibiotics.

2. Centres for Disease Control and Prevention – Travellers’ Health: Yellow Book. http://wwwn.cdc.gov/travel/yellowBookCh4-Diarrhea.aspx Accessed 23.09.14. RATIONALE: High-risk countries are defined as most of Asia, the Middle-East, Africa, Mexico, Central and Southern America. Expert opinion is that bismuth subsalicylate (Pepto-Bismol) can be used for prophylaxis: one trial found it reduced the incidence of traveller’s diarrhoea from 40% to 14%. However, adverse effects are common and, due to its salicylate content, bismuth subsalicylate has several contraindications.

3. de Bruyn, G., Hahn, S. and Borwick, A. Antibiotic treatment for travellers' diarrhoea. The Cochrane Library. Issue 3. 2000 John Wiley & Sons, Ltd. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002242/abstract Accessed 23.09.14. RATIONALE: Of 20 RCTS identified, ten RCTs evaluated short-courses of quinolones, three RCTs evaluated stat doses of quinolones, and one RCT evaluated azithromycin for travellers’ diarrhoea.

4. Steffen R, Mathewson JJ, Ericsson CD, Du Pont HL, Helminger A, Balm TK, Wolff K, Witassek F. Traveller’s diarrhoea in West Africa and Mexico: faecal transport systems and bismuth subsalicylate for self-therapy. J Infect Dis 1988;157(5):1008-13. RATIONALE: A two-day treatment course of bismuth reduced the number of stools by 17% compared with placebo.

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Document history

LHP version 1.0

Related information

Not supplied