I work in a travel-medicine clinic and prescribe chemoprophylaxis for traveler’s diarrhea (TD) to every patient leaving the country. The 1985 NIH study stating that chemoprophylaxis is not recommended as routine management is incorrect in 2011.
According to the CDC’s 2010 Yellow Book, “Obtaining reliable and timely medical care can be problematic in many destinations. As a result, prescribing certain medications in advance can empower the traveler to self-diagnose and treat common health problems.” One paragraph down, it continues, “(TD) is perhaps the most frequent indication for self-treatment. The success of this strategy is based on epidemiologic evidence that bacterial pathogens account for more than 90% of TD in short-term travelers.”
Even those who follow the advice, “Boil it, cook it, peel it, or forget it” get TD. My advice is to pack a medical kit that includes an antibiotic for self-treatment of TD with specific instructions on its use as well as OTC loperamide (Imodium A-D), an antimotility agent that provides symptomatic relief and serves as a useful adjunct to antibiotic therapy. — BECKY ELDER, FNP-C, Boise
OTC loperamide is safe enough to carry, but patients should be educated about its use and not use it indiscriminately. It is also advisable for travelers to consult with an expert who knows the bacterial flora most likely to be encountered. As a general rule, antibiotics should not be prescribed unless the risks are great enough and the practitioner is confident the patient will use it correctly. For most tourists, this is enough. — Claire Babcock O’Connell, MPH, PA-C (152-13)