More than 300 million people cross international boundarieseach year1. Diarrhea is by far the most common medical problemamong people traveling to the tropical and semitropical areasof Latin America; parts of the Caribbean, such as Haiti andthe Dominican Republic; southern Asia; and North, East, andWest Africa2. It affects 20 to 50 percent of such travelers3.The threat of diarrhea and the illness itself represent greateconomic costs to the traveling public and the host country.The loss of income from tourism and the failure of businessventures caused by the threat of illness . . . [Full Text of this Article]
Cause and Sources of Traveler's Diarrhea
Clinical Features of Traveler's Diarrhea
Prophylaxis
The Argument against Prophylaxis
The Decision to Use Prophylaxis
Treatment of Traveler's Diarrhea
Counseling Travelers to High-Risk Areas
Selecting Food and Beverages
Infants, Children, and Pregnant Women
Other Considerations
Future Developments
Source Information
From the Center for Infectious Diseases, University of Texas Medical School and School of Public Health, Houston.
Address reprint requests to Dr. DuPont at 6431 Fannin, 1.729 JFB, Houston, TX 77030.
Huang, D. B., Mohamed, J. A., Nataro, J. P., DuPont, H. L., Jiang, Z.-D., Okhuysen, P. C.
(2007). Virulence characteristics and the molecular epidemiology of enteroaggregative Escherichia coli isolates from travellers to developing countries. J Med Microbiol
56: 1386-1392
[Abstract][Full Text]
Huang, D. B., Mohanty, A., DuPont, H. L., Okhuysen, P. C., Chiang, T.
(2006). A review of an emerging enteric pathogen: enteroaggregative Escherichia coli.. J Med Microbiol
55: 1303-1311
[Abstract][Full Text]
Diemert, D. J.
(2006). Prevention and Self-Treatment of Traveler's Diarrhea. Clin. Microbiol. Rev.
19: 583-594
[Abstract][Full Text]
TAYLOR, D. N., BOURGEOIS, A. L., ERICSSON, C. D., STEFFEN, R., JIANG, Z.-D., HALPERN, J., HAAKE, R., DUPONT, H. L., THE RIFAXIMIN STUDY GROUP,
(2006). A RANDOMIZED, DOUBLE-BLIND, MULTICENTER STUDY OF RIFAXIMIN COMPARED WITH PLACEBO AND WITH CIPROFLOXACIN IN THE TREATMENT OF TRAVELERS' DIARRHEA. Am J Trop Med Hyg
74: 1060-1066
[Abstract][Full Text]
Fleck, S., Jager, H., Zeeb, H.
(2006). Travel and health status: a survey follow-up study. Eur J Public Health
16: 96-100
[Abstract][Full Text]
Freedman, D. O., Weld, L. H., Kozarsky, P. E., Fisk, T., Robins, R., von Sonnenburg, F., Keystone, J. S., Pandey, P., Cetron, M. S., the GeoSentinel Surveillance Network,
(2006). Spectrum of Disease and Relation to Place of Exposure among Ill Returned Travelers. NEJM
354: 119-130
[Abstract][Full Text]
Ko, G., Garcia, C., Jiang, Z.-D., Okhuysen, P. C., Belkind-Gerson, J., Glass, R. I., DuPont, H. L.
(2005). Noroviruses as a Cause of Traveler's Diarrhea among Students from the United States Visiting Mexico. J. Clin. Microbiol.
43: 6126-6129
[Abstract][Full Text]
DuPont, H. L., Jiang, Z.-D., Okhuysen, P. C., Ericsson, C. D., de la Cabada, F. J., Ke, S., DuPont, M. W., Martinez-Sandoval, F.
(2005). A Randomized, Double-Blind, Placebo-Controlled Trial of Rifaximin To Prevent Travelers' Diarrhea. ANN INTERN MED
142: 805-812
[Abstract][Full Text]
Gorbach, S. L.
(2005). How To Hit the Runs for Fifty Million Travelers at Risk. ANN INTERN MED
142: 861-862
[Full Text]
Huang, D. B., Musher, D., Musher, B. L.
(2005). Contagious Acute Gastrointestinal Infections. NEJM
352: 1267-1268
[Full Text]
Chapin, A. R., Carpenter, C. M., Dudley, W. C., Gibson, L. C., Pratdesaba, R., Torres, O., Sanchez, D., Belkind-Gerson, J., Nyquist, I., Karnell, A., Gustafsson, B., Halpern, J. L., Bourgeois, A. L., Schwab, K. J.
(2005). Prevalence of Norovirus among Visitors from the United States to Mexico and Guatemala Who Experience Traveler's Diarrhea. J. Clin. Microbiol.
43: 1112-1117
[Abstract][Full Text]
Pakyz, A. L
(2005). Rifaximin: A New Treatment for Travelers' Diarrhea. The Annals of Pharmacotherapy
39: 284-289
[Abstract][Full Text]
Casburn-Jones, A C, Farthing, M J G
(2004). Management of infectious diarrhoea. Gut
53: 296-305
[Full Text]
Masters, P. A., O'Bryan, T. A., Zurlo, J., Miller, D. Q., Joshi, N.
(2003). Trimethoprim-Sulfamethoxazole Revisited. Arch Intern Med
163: 402-410
[Abstract][Full Text]
Van Looveren, M., Daube, G., De Zutter, L., Dumont, J.-M., Lammens, C., Wijdooghe, M., Vandamme, P., Jouret, M., Cornelis, M., Goossens, H.
(2001). Antimicrobial susceptibilities of Campylobacter strains isolated from food animals in Belgium. J Antimicrob Chemother
48: 235-240
[Abstract][Full Text]
Marteau, P. R, Vrese, M. d., Cellier, C. J, Schrezenmeir, J.
(2001). Protection from gastrointestinal diseases with the use of probiotics. Am. J. Clin. Nutr.
73: 430S-436
[Abstract][Full Text]
Gomi, H., Jiang, Z.-D., Adachi, J. A., Ashley, D., Lowe, B., Verenkar, M. P., Steffen, R., DuPont, H. L.
(2001). In Vitro Antimicrobial Susceptibility Testing of Bacterial Enteropathogens Causing Traveler's Diarrhea in Four Geographic Regions. Antimicrob. Agents Chemother.
45: 212-216
[Abstract][Full Text]
Jiang, Z.-D., Ke, S., Palazzini, E., Riopel, L., Dupont, H.
(2000). In Vitro Activity and Fecal Concentration of Rifaximin after Oral Administration. Antimicrob. Agents Chemother.
44: 2205-2206
[Abstract][Full Text]
Ryan, E. T., Kain, K. C.
(2000). Health Advice and Immunizations for Travelers. NEJM
342: 1716-1725
[Full Text]
Vila, J., Vargas, M., Ruiz, J., Corachan, M., Jimenez de Anta, M. T., Gascon, J.
(2000). Quinolone Resistance in Enterotoxigenic Escherichia coli Causing Diarrhea in Travelers to India in Comparison with Other Geographical Areas. Antimicrob. Agents Chemother.
44: 1731-1733
[Abstract][Full Text]
de Roos, N. M, Katan, M. B
(2000). Effects of probiotic bacteria on diarrhea, lipid metabolism, and carcinogenesis: a review of papers published between 1988 and 19981. Am. J. Clin. Nutr.
71: 405-411
[Abstract][Full Text]
Hasegawa, M., Hidaka, Y., Matsumoto, Y., Sanni, T., Shimonishi, Y.
(1999). Determination of the Binding Site on the Extracellular Domain of Guanylyl Cyclase C to Heat-stable Enterotoxin. J. Biol. Chem.
274: 31713-31718
[Abstract][Full Text]
Menzies, I S, Zuckerman, M J, Nukajam, W S, Somasundaram, S G, Murphy, B, Jenkins, A P, Crane, R S, Gregory, G G
(1999). Geography of intestinal permeability and absorption. Gut
44: 483-489
[Abstract][Full Text]
Steffen, R., Collard, F., Tornieporth, N., Campbell-Forrester, S., Ashley, D., Thompson, S., Mathewson, J. J., Maes, E., Stephenson, B., DuPont, H. L., von Sonnenburg, F.
(1999). Epidemiology, Etiology, and Impact of Traveler's Diarrhea in Jamaica. JAMA
281: 811-817
[Abstract][Full Text]
Goossens, H., Sprenger, M. J W
(1998). Community acquired infections and bacterial resistance. BMJ
317: 654-657
[Full Text]
Nataro, J. P., Kaper, J. B.
(1998). Diarrheagenic Escherichia coli. Clin. Microbiol. Rev.
11: 142-201
[Abstract][Full Text]
Katelaris, P. H., Salam, I., Farthing, M. J.G.
(1995). Lactobacilli to Prevent Traveler's Diarrhea?. NEJM
333: 1360-1361
[Full Text]
Cesarman, G., Cesarman, E., Lagos, G., Osterholm, M. T., Hedberg, C. W., MacDonald, K. L., Meyers, A., DuPont, H. L., Ericsson, C. D.
(1993). Prevention and Treatment of Traveler's Diarrhea. NEJM
329: 1584-1585
[Full Text]