旅行者腹泻：临床综述
Travelers' Diarrhea: A Clinical Review.
作者信息
Leung Alexander K C, Leung Amy A M, Wong Alex H C, Hon Kam L
机构信息
Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada.
Department of Family Medicine, The University of Alberta, Edmonton, Alberta, Canada.
出版信息
Recent Pat Inflamm Allergy Drug Discov. 2019;13(1):38-48. doi: 10.2174/1872213X13666190514105054.
BACKGROUND
Travelers' diarrhea is the most common travel-related malady. It affects millions of international travelers to developing countries annually and can significantly disrupt travel plans.
OBJECTIVE
To provide an update on the evaluation, diagnosis, treatment, and prevention of traveler's diarrhea.
METHODS
A PubMed search was completed in Clinical Queries using the key term "traveler's diarrhea". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to English literature. Patents were searched using the key term "traveler's diarrhea" from www.freepatentsonline.com.
RESULTS
Between 10% and 40% of travelers develop diarrhea. The attack rate is highest for travelers from a developed country who visit a developing country. Children are at particular risk. Travelers' diarrhea is usually acquired through ingestion of food and water contaminated by feces. Most cases are due to a bacterial pathogen, commonly, Escherichia coli, and occur within the first few days after arrival in a foreign country. Dehydration is the most common complication. Pretravel education on hygiene and on the safe selection of food items is important in minimizing episodes. For mild travelers' diarrhea, the use of antibiotic is not recommended. The use of bismuth subsalicylate or loperamide may be considered. For moderate travelers' diarrhea, antibiotics such as fluoroquinolones, azithromycin, and rifaximin may be used. Loperamide may be considered as monotherapy or adjunctive therapy. For severe travelers' diarrhea, antibiotics such as azithromycin, fluoroquinolones, and rifaximin should be used. Azithromycin can be used even for the treatment of dysentery whereas fluoroquinolones and rifaximin cannot be used for such purpose. Recent patents related to the management of travelers' diarrhea are discussed.
CONCLUSION
Although travelers' diarrhea is usually self-limited, many travelers prefer expedient relief of diarrhea, especially when they are traveling for extended periods by air or ground. Judicious use of an antimotility agent and antimicrobial therapy reduces the duration and severity of diarrhea.
背景
旅行者腹泻是最常见的与旅行相关的疾病。它每年影响数百万前往发展中国家的国际旅行者，并可能严重打乱旅行计划。
目的
提供旅行者腹泻评估、诊断、治疗和预防方面的最新信息。
方法
在Clinical Queries中使用关键词“旅行者腹泻”完成PubMed检索。检索策略包括荟萃分析、随机对照试验、临床试验、观察性研究和综述。检索限于英文文献。使用来自www.freepatentsonline.com的关键词“旅行者腹泻”检索专利。
结果
10%至40%的旅行者会发生腹泻。来自发达国家前往发展中国家的旅行者发病率最高。儿童尤其危险。旅行者腹泻通常通过摄入被粪便污染的食物和水而感染。大多数病例由细菌病原体引起，常见的是大肠杆菌，且在抵达外国后的头几天内发生。脱水是最常见的并发症。旅行前进行卫生和安全选择食物的教育对于减少发病很重要。对于轻度旅行者腹泻，不建议使用抗生素。可考虑使用次水杨酸铋或洛哌丁胺。对于中度旅行者腹泻，可使用氟喹诺酮类、阿奇霉素和利福昔明等抗生素。洛哌丁胺可作为单一疗法或辅助疗法。对于重度旅行者腹泻，应使用阿奇霉素、氟喹诺酮类和利福昔明等抗生素。阿奇霉素甚至可用于治疗痢疾，而氟喹诺酮类和利福昔明则不能用于此目的。讨论了与旅行者腹泻管理相关的近期专利。
结论
尽管旅行者腹泻通常为自限性，但许多旅行者希望迅速缓解腹泻，尤其是在他们通过航空或地面长时间旅行时。明智地使用止泻剂和抗菌疗法可缩短腹泻持续时间并减轻严重程度。
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