Markwalder K
Ther Umsch. 2001 Jun;58(6):367-71. doi: 10.1024/0040-5930.58.6.367.
Diarrhea is the most common health problem of travelers to tropical destinations, affecting up to over 50%, with however considerable regional and seasonal variation. Orally acquired bacterial pathogens, particularly enterotoxigenic Escherichia coli, are the most frequent etiology of travelers' diarrhea occurring during the first three weeks of travel. Protozoal infections, e.g. giardia and Entamoeba histolytica, are more often the cause of diarrhea and prolonged problems of intestinal motility of the returning traveler--as are postinfectious irritable bowel syndromes. Prevention seems theoretically simple by avoiding any potentially contaminated food and drinks, but the principle of 'cook it, boil it, peel it, or avoid it is obviously a goal difficult to achieve. Several antibiotics have shown to be able to prevent diarrhea for a short period of time, but the potential of adverse effects and selection of resistant pathogens calls for a restrictive use for short trips of particularly vulnerable subjects only. The use of probiotics--e.g. Saccharomyces boulardi, Streptococcus faecium--gave conflicting results--both in prevention and treatment. The basics of treatment is appropriate fluid replacement--mostly by the oral route. Although this measure can safely bridge the time until spontaneous remission, it fails to reduce the duration of illness. Appropriate antibiotics are fairly effective to reduce the duration of travelers' diarrhea, especially if combined with loperamid. The administration of the later is contraindicated in small children. The most commonly used and well documented antibiotics belong to the fluoroquinolones. Alternatives for pediatric use are azithromycin and cotrimoxazole. Considering the mostly short duration of travelers' diarrhea the administration of antibiotics can be limited to cases of acute febrile dysentery and violent diarrhea when rapid relief is essential. In cases of febrile diarrhea malaria must be considered if the patient has been exposed to the risk of transmission.
腹泻是前往热带地区旅行者最常见的健康问题，影响高达50%以上的人，不过存在显著的地区和季节差异。经口感染的细菌病原体，尤其是产肠毒素大肠杆菌，是旅行前三周发生的旅行者腹泻最常见的病因。原生动物感染，如贾第虫和溶组织内阿米巴，更常是返程旅行者腹泻和肠道运动长期问题的原因——感染后肠易激综合征也是如此。从理论上讲，通过避免食用任何可能被污染的食物和饮料来预防似乎很简单，但“煮熟、煮沸、去皮或避开”的原则显然是一个难以实现的目标。几种抗生素已显示能够在短时间内预防腹泻，但不良反应的可能性和耐药病原体的选择要求仅对特别易感染的受试者进行短途旅行时限制使用。益生菌（如布拉酵母菌、粪肠球菌）的使用在预防和治疗方面都产生了相互矛盾的结果。治疗的基础是适当的液体补充——大多通过口服途径。虽然这项措施可以安全地度过直到自然缓解的时间，但它并不能缩短疾病的持续时间。适当的抗生素对缩短旅行者腹泻的持续时间相当有效，尤其是与洛哌丁胺联合使用时。后者在幼儿中禁用。最常用且有充分记录的抗生素属于氟喹诺酮类。儿科使用的替代药物是阿奇霉素和复方新诺明。考虑到旅行者腹泻大多持续时间较短，抗生素的使用可仅限于急性发热性痢疾和剧烈腹泻且急需快速缓解的情况。在发热性腹泻的情况下，如果患者有感染传播风险，必须考虑疟疾。
