Traveler's diarrhea - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Traveler's diarrhea is a common problem among travelers to destinations with deficiencies in water, sanitation, and hygiene (WASH) infrastructure, typically caused by the consumption of contaminated food or water. Predominantly caused by bacteria.
Prevention strategies include careful selection of food and beverages, though these are not fail-safe. Prophylactic antibiotics are not recommended for most travelers.
Management is self-diagnosis while still traveling, followed by hydration, medications for symptom relief, and possibly, antibiotics. Antibiotic therapy is generally reserved for moderate to severe infections.
In healthy patients, resolution is typically within 3-5 days even without antibiotic treatment.

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History & Exam
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Definition

Epidemiology

Etiology

Pathophysiology

Citations

Key Articles

Riddle MS, Connor BA, Beeching NJ, et al. Guidelines for the prevention and treatment of travelers' diarrhea: a graded expert panel report. J Travel Med. 2017 Apr 1;24(suppl 1):S57-74.[Abstract][Full Text]
Centers for Disease Control and Prevention. CDC Yellow Book 2024: health information for international travel. Section 2: preparing international travelers - travelers' diarrhea. May 2023 [internet publication].[Full Text]
De Bruyn G, Hahn S, Borwick A. Antibiotic treatment for travellers' diarrhoea. Cochrane Database Syst Rev. 2000;(3):CD002242.[Abstract][Full Text]
Johnson PC, Ericsson CD, DuPont HL, et al. Comparison of loperamide with bismuth subsalicylate for the treatment of acute travelers' diarrhea. JAMA. 1986 Feb 14;255(6):757-60.[Abstract]

Referenced Articles

1. Riddle MS, Connor BA, Beeching NJ, et al. Guidelines for the prevention and treatment of travelers' diarrhea: a graded expert panel report. J Travel Med. 2017 Apr 1;24(suppl 1):S57-74.[Abstract][Full Text]
2. Centers for Disease Control and Prevention. CDC Yellow Book 2024: health information for international travel. Section 2: preparing international travelers - travelers' diarrhea. May 2023 [internet publication].[Full Text]
3. Michal Stevens A, Esposito DH, Stoney RJ, et al. Clostridium difficile infection in returning travellers. J Travel Med. 2017 May 1;24(3):10.[Abstract][Full Text]
4. Adler AV, Ciccotti HR, Trivitt SJH, et al. What's new in travellers' diarrhoea: updates on epidemiology, diagnostics, treatment and long-term consequences. J Travel Med. 2022 Jan 17;29(1):taab099.[Abstract][Full Text]
5. Duplessis CA, Gutierrez RL, Porter CK. Review: chronic and persistent diarrhea with a focus in the returning traveler. Trop Dis Travel Med Vaccines. 2017 May 4;3:9.[Abstract][Full Text]
6. Connor BA, Riddle MS. Post-infectious sequelae of travelers' diarrhea. J Travel Med. 2013 Sep-Oct;20(5):303-12.[Abstract][Full Text]
7. Centers for Disease Control and Prevention. CDC Yellow Book: health information for international travel. Section 11: posttravel evaluation - persistent diarrhea in returned travelers. May 2023 [internet publication].[Full Text]
8. Lalani T, Maguire JD, Grant EM, et al. Epidemiology and self-treatment of travelers' diarrhea in a large, prospective cohort of department of defense beneficiaries. J Travel Med. 2015 May-Jun;22(3):152-60.[Abstract][Full Text]
9. Steffen R, Hill DR, DuPont HL. Traveler's diarrhea: a clinical review. JAMA. 2015 Jan 6;313(1):71-80.[Abstract]
10. Steffen R, Tornieporth N, Clemens SA, et al. Epidemiology of travelers' diarrhea: details of a global survey. J Travel Med. 2004 Jul-Aug;11(4):231-7.[Abstract][Full Text]
11. Barrett J, Brown M. Travellers' diarrhoea. BMJ. 2016 Apr 19;353:i1937.[Abstract]
12. Pender MA, Smith T, Brintz BJ, et al. Weather variables as important clinical predictors of bacterial diarrhoea among international travellers. J Travel Med. 2022 Jul 14;29(4):taac012.[Abstract][Full Text]
13. Porter CK, Olson S, Hall A, et al. Travelers' diarrhea: an update on the incidence, etiology, and risk in military deployments and similar travel populations. Mil Med. 2017 Sep;182(s2):4-10.[Abstract][Full Text]
14. Walters WA, Reyes F, Soto GM, et al. Epidemiology and associated microbiota changes in deployed military personnel at high risk of traveler's diarrhea. PLoS One. 2020;15(8):e0236703.[Abstract][Full Text]
15. Lääveri T, Vilkman K, Pakkanen SH, et al. A prospective study of travellers' diarrhoea: analysis of pathogen findings by destination in various (sub)tropical regions. Clin Microbiol Infect. 2017 Nov 10;24(8):908.e9-16.[Abstract]
16. Lertsethtakarn P, Silapong S, Sakpaisal P, et al. Travelers' diarrhea in Thailand: a quantitative analysis using TaqMan® array card. Clin Infect Dis. 2018 Jun 18;67(1):120-7.[Abstract][Full Text]
17. Schaumburg F, Correa-Martinez CL, Niemann S, et al. Aetiology of traveller's diarrhea: a nested case-control study. Travel Med Infect Dis. 2020 Sep-Oct;37:101696.[Abstract]
18. Bodhidatta L, Anuras S, Sornsakrin S, et al. Epidemiology and etiology of traveler's diarrhea in Bangkok, Thailand, a case-control study. Trop Dis Travel Med Vaccines. 2019 Jun 7;5:9.[Abstract][Full Text]
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20. U.S. Food and Drug Administration. Bad bug book: handbook of foodborne pathogenic microorganisms and natural toxins. Second edition. 2012 [internet publication].[Full Text]
21. Bacaner N, Stauffer B, Boulware D, et al. Travel medicine considerations for North American immigrants visiting friends and relatives. JAMA. 2004 Jun 16;291(23):2856-64.[Abstract][Full Text]
22. Centers for Disease Control and Prevention. CDC Yellow Book: health information for international travel. Section 2: preparing international travelers - food and water precautions. May 2023 [internet publication].[Full Text]
23. Hu Y, Ren J, Zhan M, et al. Efficacy of rifaximin in prevention of travelers' diarrhea: a meta-analysis of randomized, double-blind, placebo-controlled trials. J Travel Med. 2012 Dec;19(6):352-6.[Abstract][Full Text]
24. Alajbegovic S, Sanders JW, Atherly DE, et al. Effectiveness of rifaximin and fluoroquinolones in preventing travelers' diarrhea (TD): a systematic review and meta-analysis. Syst Rev. 2012 Aug 28;1:39.[Abstract][Full Text]
25. Martinez-Sandoval F, Ericsson CD, Jiang ZD, et al. Prevention of travelers' diarrhea with rifaximin in US travelers to Mexico. J Travel Med. 2010 Mar-Apr;17(2):111-7.[Abstract][Full Text]
26. DuPont HL, Ericsson CD, Johnson PC, et al. Prevention of traveler's diarrhea by the tablet formulation of bismuth subsalicylate. JAMA. 1987 Mar 13;257(10):1347-50.[Abstract]
27. Brum JM, Gibb RD, Ramsey DL, et al. Systematic review and meta-analyses assessment of the clinical efficacy of bismuth subsalicylate for prevention and treatment of infectious diarrhea. Dig Dis Sci. 2021 Jul;66(7):2323-35.[Abstract][Full Text]
28. Riddle MS, DuPont HL, Connor BA. ACG clinical guideline: diagnosis, treatment, and prevention of acute diarrheal infections in adults. Am J Gastroenterol. 2016 May;111(5):602-22.[Abstract][Full Text]
29. Shane AL, Mody RK, Crump JA, et al. 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea. Clin Infect Dis. 2017 Nov 29;65(12):1963-73.[Abstract][Full Text]
30. Miller JM, Binnicker MJ, Campbell S, et al. Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis. 2024 Mar 5:ciae104.[Abstract][Full Text]
31. American Society for Clinical Laboratory Science. Ten things physicians and patients should question. Choosing Wisely, an initiative of the ABIM Foundation. 2022 [internet publication].[Full Text]
32. Vila J. New molecular diagnostic tools in traveller's diarrhea. J Travel Med. 2017 Apr 1;24(suppl 1):S23-28.[Abstract][Full Text]
33. Farthing M, Salam MA, Lindberg G, et al. Acute diarrhea in adults and children: a global perspective. J Clin Gastroenterol. 2013 Jan;47(1):12-20.[Abstract][Full Text]
34. De Bruyn G, Hahn S, Borwick A. Antibiotic treatment for travellers' diarrhoea. Cochrane Database Syst Rev. 2000;(3):CD002242.[Abstract][Full Text]
35. Kantele A, Lääveri T, Mero S, et al. Antimicrobials increase travelers' risk of colonization by extended-spectrum betalactamase-producing Enterobacteriaceae. Clin Infect Dis. 2015 Mar 15;60(6):837-46.[Abstract][Full Text]
36. Connor BA, Keystone JS. Antibiotic self-treatment of travelers' diarrhea: helpful or harmful? Clin Infect Dis. 2015 Mar 15;60(6):847-8.[Abstract][Full Text]
37. Rusu A, Munteanu AC, Arbănași EM, et al. Overview of side-effects of antibacterial fluoroquinolones: new drugs versus old drugs, a step forward in the safety profile? Pharmaceutics. 2023 Mar 1;15(3):804.[Abstract][Full Text]
38. Bruzzese E, Giannattasio A, Guarino A. Antibiotic treatment of acute gastroenteritis in children. F1000Res. 2018 Feb 15;7:193.[Abstract][Full Text]
39. Johnson PC, Ericsson CD, DuPont HL, et al. Comparison of loperamide with bismuth subsalicylate for the treatment of acute travelers' diarrhea. JAMA. 1986 Feb 14;255(6):757-60.[Abstract]
40. Riddle MS, Arnold S, Tribble DR. Effect of adjunctive loperamide in combination with antibiotics on treatment outcomes in traveler's diarrhea: a systematic review and meta-analysis. Clin Infect Dis. 2008 Oct 15;47(8):1007-14.[Abstract][Full Text]
41. Halani S, Wu PE. Salicylate toxicity from chronic bismuth subsalicylate use. BMJ Case Rep. 2020 Nov 30;13(11):e236929.[Abstract][Full Text]
42. ClinicalTrials.gov. Clinical study to assess the efficacy of IMM-124E (Travelan®) in a controlled human infection model. Mar 2024 [internet publication].[Full Text]
43. Guo Q, Goldenberg JZ, Humphrey C, et al. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database Syst Rev. 2019 Apr 30;(4):CD004827.[Abstract][Full Text]
44. Pérez-Gaxiola G, Cuello-García CA, Florez ID, et al. Smectite for acute infectious diarrhoea in children. Cochrane Database Syst Rev. 2018 Apr 25;4:CD011526.[Abstract][Full Text]
45. Public Health Agency of Canada. Statement on travellers' diarrhea. 2015 [internet publication].[Full Text]
46. Tuompo R, Lääveri T, Hannu T, et al. Reactive arthritis and other musculoskeletal symptoms associated with acquisition of diarrhoeagenic Escherichia coli (DEC). Ann Rheum Dis. 2020 May;79(5):605-11.[Abstract][Full Text]