Wyss Maria N, Steffen Robert, Dhupdale Nitin Y, Thitiphuree Sumit, Mutsch Margot
Division of Epidemiology and Prevention of Communicable Diseases, World Health Organization Collaborating Centre for Travellers' Health, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.
J Travel Med. 2009 May-Jun;16(3):186-90. doi: 10.1111/j.1708-8305.2009.00335.x.
There is an ongoing debate as to whether patients with travelers' diarrhea (TD) should self-medicate with a travel kit in developing countries or whether they should consult local doctors. Thus, we have analyzed TD management conducted by local health professionals.
Practicing physicians recommended to tourists in Goa (India), Mombasa (Kenya), and Phuket (Thailand) were invited to participate in a cross-sectional questionnaire survey. Three TD case descriptions were presented, and suggested diagnostic and therapeutic procedures were analyzed.
In each of the three locations, approximately 20 physicians (59 in total, response rate 95%) completed the questionnaires. Oral rehydration was proposed by more than 80% of the physicians for mild cases of TD and for TD with vomiting, while 73% of them would have treated febrile TD patients orally and 17% would have used intravenous (IV) fluids. Antimicrobials, primarily fluoroquinolones, would have been prescribed for 61, 73, and 95%, respectively, of these three cases. Cephalosporins, aminoglycosides (usually IV gentamicin), IV amoxicillin, and once co-trimoxazole were recommended. Many medical doctors added nitroimidazole to the antibiotic therapy. Multiple symptomatic drugs would have been prescribed. The rate of invasive procedures (infusions, injections, and diagnostic venipuncture) would have ranged from 20% to 86% in the scenarios of the different patients. Mainly practitioners who owned a clinic would have hospitalized patients with TD.
Many physicians in destination countries treat TD patients similarly to the treatments prescribed in the "Western world." A minority uses obsolete antimicrobials. Polypharmacy and the high rate of invasive procedures with a theoretical risk of nosocomial infection are of concern. Training initiatives for both local physicians and travelers might be beneficial, and the guidelines should be based on internationally accepted expert advice.
对于在发展中国家患旅行者腹泻（TD）的患者是应使用旅行用药套装自行治疗还是应咨询当地医生，目前仍存在争议。因此，我们分析了当地卫生专业人员对TD的管理情况。
邀请在果阿邦（印度）、蒙巴萨（肯尼亚）和普吉岛（泰国）为游客提供服务的执业医师参与一项横断面问卷调查。呈现了3个TD病例描述，并对建议的诊断和治疗程序进行了分析。
在这三个地点中的每个地点，约20名医师（共59名，回复率95%）完成了问卷。超过80%的医师建议对轻度TD病例以及伴有呕吐的TD采用口服补液，而其中73%的医师会对发热的TD患者进行口服治疗，17%的医师会使用静脉输液。在这三种病例中，分别有61%、73%和95%的病例会使用抗菌药物，主要是氟喹诺酮类。还推荐了头孢菌素、氨基糖苷类（通常为静脉注射庆大霉素）、静脉注射阿莫西林以及一次复方新诺明。许多医生在抗生素治疗中添加了硝基咪唑。会开具多种对症药物。在不同患者的病例场景中，侵入性操作（输液、注射和诊断性静脉穿刺）的比例在20%至86%之间。主要是拥有诊所的从业者会将TD患者收住院。
目的地国家的许多医师对TD患者的治疗方式与“西方世界”规定的治疗方式相似。少数人使用过时的抗菌药物。联合用药以及具有医院感染理论风险的高侵入性操作比例令人担忧。针对当地医师和旅行者的培训举措可能会有益，并且指南应基于国际认可的专家建议。
