Published: 2021-11-24

Prophylaxis, diagnosis, and treatment of Traveler’s diarrhea

Hamed Saeed Al-Ghamdi, Abdulrahman Hamza Altokhy, Nawal Hussain Bin Jalalah, Dhiyaa Hassan Aldukhi, Naif Ayidh Almalki, Saad Abdullah Alahmari, Alaa Ahmed Harir, Manar Salah Ahmed, Abdulrahman Hafidh Alghamdi, Wafa Ibrahim Alzahimi, Abdulmohsin Mohammed Altuwaijri


Evidence still indicates that traveler’s diarrhea might have unpleasant consequences over the affected patients’ time and health, and can increase the frequency of hospitalization and other health-related parameters. As a result of the newly developing serious issues about the resistance of bacteria to the different antibiotics, the management guidelines of traveler’s diarrhea are frequently changing based on this new data to ensure that proper management is delivered to the affected patients and enhance the healthcare practices. In the present literature review, we have discussed the diagnosis, treatment, and prophylaxis against traveler’s diarrhea based on evidence from the current investigations in the literature. The diagnosis of the condition is mainly based on the presence of symptoms suggestive of gastroenteritis, and having a travel history to an endemic country. Besides, cultures might be needed in certain situations to indicate the diagnosis, especially among resistant cases. The best prophylactic approach is to enhance the eating and drinking practices when travelling to endemic countries, in addition to the frequent washing of ingested food by clean water that is obtained from a safe source. The administration of antibiotics is not always recommended, and only moderate and severe cases should be indicated to receive antibiotics based on their clinical evaluation. The administered antibiotics should be based on the resistance and safety profiles among each country to enhance the efficacy of these antibiotics and obtain favorable outcomes.


Traveler’s diarrhea, Prophylaxis, Treatment, Management, Diagnosis, Evaluation

Full Text:



Steffen R, Hill DR, DuPont HL. Traveler's diarrhea: a clinical review. Jama. 2015;313(1):71-80.

Murray CJ, Barber RM, Foreman KJ, et al. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition. Lancet. 2015;386(10009):2145-91.

Riddle MS, Connor BA, Beeching NJ. Guidelines for the prevention and treatment of travelers’ diarrhea: a graded expert panel report. Journal of Travel Medicine. 2017;24(1):S63-80.

Fernandes HVJ, Houle SKD, Johal A, Riddle MS. Travelers' diarrhea: Clinical practice guidelines for pharmacists. Canadian pharmacists J. 2019;152(4):241-50.

Dunn N, Okafor CN. Travelers Diarrhea. In: StatPearls. Treasure Island (FL): StatPearls Publishing Copyright, StatPearls Publishing LLC. 2021.

Riddle MS, DuPont HL, Connor BA. ACG Clinical Guideline: Diagnosis, Treatment, and Prevention of Acute Diarrheal Infections in Adults. Am J gastroenterol. 2016;111(5):602-22.

on Sonnenburg F, Tornieporth N, Waiyaki P. Risk and aetiology of diarrhoea at various tourist destinations. Lancet. 2000;356(9224):133-4.

Connor BA, Rogova M, Whyte O. Use of a multiplex DNA extraction PCR in the identification of pathogens in travelers' diarrhea. J Travel Med. 2018;25:1.

Levi ME. Identification and Management of Traveler's Diarrhea. J Midwifery Women's Health. 2021;66(3):380-4.

Riddle MS, Connor BA, Beeching NJ. Guidelines for the prevention and treatment of travelers' diarrhea: a graded expert panel report. J Travel Med. 2017;24(1):S57-74.

DuPont HL, Sullivan P, Evans DG. Prevention of traveler's diarrhea (emporiatric enteritis). Prophylactic administration of subsalicylate bismuth). JAMA. 1980;243(3):237-41.

DuPont HL, Ericsson CD, Johnson PC, Bitsura JA, DuPont MW, De la Cabada FJ. Prevention of travelers' diarrhea by the tablet formulation of bismuth subsalicylate. JAMA. 1987;257(10):1347-50.

Roupa Z, Zikos D, Vasilopoulos A, Diomidous M. Common Health Risks, Required Precautions of Travelers and their Customs Towards the Use of Travel Medicine Services. Materia socio-medica. 2012;24(2):131-4.

Lestelle C, Aymeric S, Maakaroun-Vermesse Z. Impact of advice given to travelers concerning the main infectious risks associated with traveling in the tropics. Medecine et maladies infectieuses. 2015;45(6):222-8.

Johnson PC, Ericsson CD, DuPont HL, Morgan DR, Bitsura JA, Wood LV. Comparison of loperamide with bismuth subsalicylate for the treatment of acute travelers' diarrhea. JAMA. 1986;255(6):757-60.

Dupont HL, Jiang ZD, Belkind-Gerson J. Treatment of travelers' diarrhea: randomized trial comparing rifaximin, rifaximin plus loperamide, and loperamide alone. Clin gastroenterol hepatol. 2007;5(4):451-6.

Lalani T, Maguire JD, Grant EM. Epidemiology and self-treatment of travelers' diarrhea in a large, prospective cohort of department of defense beneficiaries. J Travel Med. 2015;22(3):152-60.

Hill DR. Occurrence and self-treatment of diarrhea in a large cohort of Americans traveling to developing countries. Am j trop med hygiene. 2000;62(5):585-9.

Statement on new oral cholera and travellers' diarrhea vaccination. Canada communicable disease report = Releve des maladies transmissibles au Canada. 2005;31(Acs-7):1-11.

DuPont HL, Ericsson CD, Farthing MJ. Expert review of the evidence base for self-therapy of travelers' diarrhea. J Travel Med. 2009;16(3):161-71.

Ericsson CD, DuPont HL, Okhuysen PC, Jiang ZD, DuPont MW. Loperamide plus azithromycin more effectively treats travelers' diarrhea in Mexico than azithromycin alone. J Travel Med. 2007;14(5):312-9.

Ouyang-Latimer J, Jafri S, VanTassel A. In vitro antimicrobial susceptibility of bacterial enteropathogens isolated from international travelers to Mexico, Guatemala, and India from 2006 to 2008. Antimicrobial agents chemotherapy. 2011;55(2):874-8.

Tisdale JE. Drug-induced QT interval prolongation and torsades de pointes: Role of the pharmacist in risk assessment, prevention and management. Canadian pharmacists j. 2016;149(3):139-52.

Riddle MS, Connor P, Fraser J. Trial Evaluating Ambulatory Therapy of Travelers' Diarrhea (TrEAT TD) Study: A Randomized Controlled Trial Comparing 3 Single-Dose Antibiotic Regimens With Loperamide. Clin infect diseases. 2017;65(12):2008-17.

Tribble DR, Sanders JW, Pang LW. Traveler's diarrhea in Thailand: randomized, double-blind trial comparing single-dose and 3-day azithromycin-based regimens with a 3-day levofloxacin regimen. Clin infect diseases. 2007;44(3):338-46.

Barrett J, Brown M. Travellers' diarrhoea. BMJ. 2016;353:i1937.

Thieu H, Bach Dat B, Nam NH, et al. Antibiotic resistance of Helicobacter pylori infection in a children's hospital in Vietnam: prevalence and associated factors. Minerva medica. 2020;111(5):498-501.