Yates Johnnie
CIWEC Clinic Travel Medicine Center, Kathmandu, Nepal.
Am Fam Physician. 2005 Jun 1;71(11):2095-100.
Acute diarrhea affects millions of persons who travel to developing countries each year. Food and water contaminated with fecal matter are the main sources of infection. Bacteria such as enterotoxigenic Escherichia coli, enteroaggregative E. coli, Campylobacter, Salmonella, and Shigella are common causes of traveler's diarrhea. Parasites and viruses are less common etiologies. Travel destination is the most significant risk factor for traveler's diarrhea. The efficacy of pretravel counseling and dietary precautions in reducing the incidence of diarrhea is unproven. Empiric treatment of traveler's diarrhea with antibiotics and loperamide is effective and often limits symptoms to one day. Rifaximin, a recently approved antibiotic, can be used for the treatment of traveler's diarrhea in regions where noninvasive E. coli is the predominant pathogen. In areas where invasive organisms such as Campylobacter and Shigella are common, fluoroquinolones remain the drug of choice. Azithromycin is recommended in areas with quinolone-resistant Campylobacter and for the treatment of children and pregnant women.
急性腹泻每年影响着数百万前往发展中国家旅行的人。被粪便污染的食物和水是主要感染源。产肠毒素大肠杆菌、聚集性大肠杆菌、弯曲杆菌、沙门氏菌和志贺氏菌等细菌是旅行者腹泻的常见病因。寄生虫和病毒是较不常见的病因。旅行目的地是旅行者腹泻最重要的风险因素。旅行前咨询和饮食预防措施在降低腹泻发病率方面的效果尚未得到证实。用抗生素和洛哌丁胺对旅行者腹泻进行经验性治疗是有效的，且通常可将症状限制在一天以内。利福昔明是一种最近获批的抗生素，可用于非侵袭性大肠杆菌为主要病原体的地区治疗旅行者腹泻。在弯曲杆菌和志贺氏菌等侵袭性微生物常见的地区，氟喹诺酮类药物仍是首选药物。在弯曲杆菌对喹诺酮耐药的地区以及用于儿童和孕妇治疗时，推荐使用阿奇霉素。
