Travelers' Diarrhea Prophylaxis Guidelines
Introduction to Prophylaxis Options
- The Journal of Travel Medicine recommends bismuth subsalicylate as the appropriate prophylaxis option for travelers' diarrhea, as antimicrobial prophylaxis should not be used routinely and fluoroquinolones are specifically not recommended for prophylaxis 1, 2
Why Not Fluoroquinolones
- Fluoroquinolones are explicitly not recommended for prophylaxis of travelers' diarrhea according to current guidelines, with a strong recommendation and low/very low level of evidence, due to the risk of adverse effects, particularly in patients with renal impairment 1, 2
- The American College of Travel Medicine suggests that fluoroquinolones should be reserved for treatment of moderate-to-severe cases, not prevention, in order to minimize the risk of resistance and adverse effects 1, 2
Why Bismuth Subsalicylate is Appropriate
- Bismuth subsalicylate may be considered for any traveler to prevent travelers' diarrhea, with a strong recommendation and high level of evidence, as it is the only non-antimicrobial prophylactic agent with strong evidence supporting its use 1, 2
- The Centers for Disease Control and Prevention recommend bismuth subsalicylate as a prophylactic option for travelers' diarrhea, due to its ability to prevent 40-60% of episodes in short-term travelers 1, 2
When Antimicrobial Prophylaxis Would Be Considered
- Antimicrobial prophylaxis should not be used routinely in travelers, with a strong recommendation, and should only be considered for travelers at high risk of health-related complications of travelers' diarrhea, such as those with underlying medical conditions or immunosuppression 1, 2
- The World Health Organization suggests that rifaximin would be the recommended antimicrobial if prophylaxis were deemed necessary for high-risk travelers, due to its safety profile and efficacy 1, 2