Libman M
Division of Infectious Disease, McGill University Health Centre, Montréal, QC.
Can Commun Dis Rep. 2015 Nov 5;41(11):272-284. doi: 10.14745/ccdr.v41i11a03.
Most travellers' diarrhea (TD) infections occur during travel to low- and middle-income countries. Type of travel, duration of stay, age of traveller and presence of certain medical conditions are important factors to consider for risk of TD. The Committee to Advise on Tropical Medicine and Travel (CATMAT) assembled a TD working group to develop recommendations on prevention and treatment of TD in travellers. This document is a summary of the .
Following a systematic review of the literature, recommendations on the prevention and treatment of TD were developed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology to evaluate data quality, benefits and harms of the intervention, and values and preferences of the traveller. Other recommendations were based on a review of the literature and expert opinion.
Using the GRADE methodology, CATMAT concluded that oral cholera vaccine should not be routinely recommended to prevent TD in Canadian travellers. This recommendation was based on moderate quality data that showed this vaccine was not effective in preventing TD in travellers compared to placebo. Bismuth subsalicylate (BSS), fluoroquinolones or rifaximin are options for the prevention of TD based on high-quality data for BSS and fluoroquinolones and moderate evidence for rifaximin. For the treatment of TD, loperamide (alone or in combination with antibiotics), fluoroquinolones, azithromycin and rifaximin are all options, with varying degrees of data quality. Based on available evidence and expert opinion, CATMAT recommends handwashing or the use of hand sanitizer, as well as prudent choice and preparation of food and beverages as best practices for preventing diarrhea while travelling. At this time, a recommendation cannot be made for either the use of probiotics and prebiotics to prevent TD or the use of BSS to treat TD due to insufficient available evidence.
With the exception of BSS for prevention of TD (strong recommendation for use), CATMAT conditionally recommends the use of each of the other GRADE-evaluated preventive and therapeutic products assessed in this Statement. These CATMAT recommendations should be considered as options in the prevention and treatment of TD based on the particular situation of the traveller.
大多数旅行者腹泻（TD）感染发生在前往低收入和中等收入国家的旅行期间。旅行类型、停留时间、旅行者年龄以及某些医疗状况的存在是考虑TD风险的重要因素。热带医学与旅行咨询委员会（CATMAT）组建了一个TD工作组，以制定关于旅行者TD预防和治疗的建议。本文件是……的总结。
在对文献进行系统综述之后，采用推荐分级评估、制定与评价（GRADE）方法制定了关于TD预防和治疗的建议，以评估数据质量、干预措施的益处和危害以及旅行者的价值观和偏好。其他建议基于文献综述和专家意见。
使用GRADE方法，CATMAT得出结论，不应常规推荐口服霍乱疫苗来预防加拿大旅行者的TD。该建议基于中等质量的数据，这些数据表明与安慰剂相比，这种疫苗在预防旅行者TD方面无效。基于次水杨酸铋（BSS）和氟喹诺酮类药物的高质量数据以及利福昔明的中等证据，BSS、氟喹诺酮类药物或利福昔明是预防TD的选择。对于TD的治疗，洛哌丁胺（单独使用或与抗生素联合使用）、氟喹诺酮类药物、阿奇霉素和利福昔明都是选择，数据质量各不相同。基于现有证据和专家意见，CATMAT建议洗手或使用洗手液，以及谨慎选择和准备食物及饮料，作为旅行期间预防腹泻的最佳做法。目前，由于现有证据不足，无法就使用益生菌和益生元预防TD或使用BSS治疗TD提出建议。
除了用于预防TD的BSS（强烈推荐使用）外，CATMAT有条件地推荐本声明中评估的其他经GRADE评估的预防和治疗产品。应根据旅行者的具体情况，将这些CATMAT建议视为TD预防和治疗的选择。
