Materiały źródłowe

• #1 Diarrhea: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/4108-diarrhea

  You cant always prevent diarrhea, but you can reduce your risk of getting it because of infections or food contamination. […] Practice good hygiene: Wash your hands with soap and water after using the bathroom or preparing and eating food. Another option is to use hand sanitizer. […] Get vaccinated: The rotavirus vaccine prevents rotavirus, a common cause of diarrhea. The vaccine for COVID-19 can reduce your risk of getting COVID and experiencing COVID symptoms, including diarrhea. […] Store food properly: Store food at the correct temperatures, and cook all foods until they reach the recommended temperatures. Dont take chances by consuming foods or drinks past their expiration dates. […] Watch what you drink when you travel: Dont drink untreated water when you travel. Avoid tap water, ice cubes or brushing your teeth with tap water. Steer clear of unpasteurized milk or juice products. Pasteurization is a process that kills germs in certain drinks. When in doubt, drink bottled water or something thats been boiled first (coffee or tea). […] Watch what you eat when you travel: Avoid raw or undercooked meats (and shellfish), as well as raw fruits and vegetables. Fruits and veggies are usually healthy options, but the skin may contain contaminants that can make you sick.

• #2 Prevention and Self-Treatment of Traveler’s Diarrhea

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1539099/

  Of the millions who travel from the industrialized world to developing countries every year, between 20% and 50% will develop at least one episode of diarrhea, making it the most common medical ailment afflicting travelers. […] Precautions can be taken to minimize the risk of developing traveler’s diarrhea, either through avoidance of potentially contaminated food or drink or through various prophylactic measures, including both nonpharmacological and antimicrobial strategies. […] In the future, vaccinesseveral of which are in the advanced stages of clinical testingmay be added to the list of prophylactic measures. […] Prevention of traveler’s diarrhea falls into four broad categories: immunization, avoidance, nonpharmacological therapy, and antibiotic prophylaxis. […] A live-attenuated oral cholera vaccine (Mutacol, Orochol) has been shown to have protective efficacy as high as 90% when recipients were challenged with Vibrio cholerae within 3 months of vaccination.

• #3 Prevention and Self-Treatment of Traveler’s Diarrhea

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1539099/

  Of the millions who travel from the industrialized world to developing countries every year, between 20% and 50% will develop at least one episode of diarrhea, making it the most common medical ailment afflicting travelers. […] Precautions can be taken to minimize the risk of developing traveler’s diarrhea, either through avoidance of potentially contaminated food or drink or through various prophylactic measures, including both nonpharmacological and antimicrobial strategies. […] In the future, vaccinesseveral of which are in the advanced stages of clinical testingmay be added to the list of prophylactic measures. […] Prevention of traveler’s diarrhea falls into four broad categories: immunization, avoidance, nonpharmacological therapy, and antibiotic prophylaxis. […] A live-attenuated oral cholera vaccine (Mutacol, Orochol) has been shown to have protective efficacy as high as 90% when recipients were challenged with Vibrio cholerae within 3 months of vaccination.

• #4 Travelers’ diarrhea: Treatment and prevention – UpToDate

  https://www.uptodate.com/contents/travelers-diarrhea-clinical-manifestations-diagnosis-and-treatment

  Travelers’ diarrhea refers to development of unformed stools associated with travel to a region where sanitation and hygienic practices are poor and there is limited access to safe drinking water. It is the most common travel-associated illness; among travelers to such regions, 30 to 70 percent develop diarrhea. […] The treatment and prevention of travelers’ diarrhea are discussed here. […] Guidance for prevention includes food and drink selection, vaccination, and limited role for antibiotics. […] Prophylaxis is mentioned as a limited role for antibiotics.

• #5 Diarrhea: Causes, treatment, and symptoms

  https://www.medicalnewstoday.com/articles/158634

  The following can help prevent diarrhea: […] drinking clean and safe water only […] having good sanitation systems, such as wastewater and sewage […] having good hygiene practices, such as regularly washing the hands with soap, especially before preparing food and eating and after using the bathroom […] educating oneself on the spread of infection. […] There is evidence to suggest that interventions from public health bodies to promote hand-washing can reduce diarrhea rates by about one-third. […] In developing countries, however, the prevention of diarrhea may be more challenging due to dirty water and poor sanitation.

• #6

  https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease

  Diarrhoeal disease is both preventable and treatable. […] A significant proportion of diarrhoeal disease can be prevented through safe drinking-water and adequate sanitation and hygiene. […] Interventions to prevent diarrhoea, including safe drinking-water, use of improved sanitation and hand washing with soap, can reduce disease risk. […] Key measures to prevent diarrhoea include: access to safe drinking-water, use of improved sanitation, hand washing with soap, exclusive breastfeeding for the first 6 months of life, good personal and food hygiene, health education about how infections spread, rotavirus vaccination. […] WHO works with Member States and other partners to promote national policies and investments that support case management of diarrhoea and its complications as well as increasing access to safe drinking-water and sanitation in developing countries. […] conduct research to develop and test new diarrhoea prevention and control strategies in this area.

• #7 Approach to Treatment and Prevention of Traveler’s Diarrhea

  https://www.uspharmacist.com/article/approach-to-treatment-and-prevention-of-travelers-diarrhea

  Hand washing has been shown to reduce the incidence of diarrhea by up to 30% in community settings. […] Travelers should routinely wash their hands using soap and water while preparing food, before eating, and after using the toilet. […] Bismuth subsalicylate (BSS), the active ingredient in Pepto-Bismol, has been shown to be effective in the prevention of TD. […] To date, the safety of BSS use beyond 3 weeks has not been established. […] Although prophylactic antibiotics have been shown to be effective for TD, they are not recommended in most situations because of the risk of adverse reactions and the risk of antibiotic resistance should a serious infection occur. […] Ciprofloxacin and rifaximina nonabsorbed antibiotic that achieves high concentrations in the intestine can prevent TD, with efficacy rates of 70% to 90%. […] In most cases, TD is acquired primarily through the consumption of contaminated food or water. […] TD can be prevented with proper education and may be treated with OTC products and prescription antibiotics.

• #8 Diarrhea: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/4108-diarrhea

  You cant always prevent diarrhea, but you can reduce your risk of getting it because of infections or food contamination. […] Practice good hygiene: Wash your hands with soap and water after using the bathroom or preparing and eating food. Another option is to use hand sanitizer. […] Get vaccinated: The rotavirus vaccine prevents rotavirus, a common cause of diarrhea. The vaccine for COVID-19 can reduce your risk of getting COVID and experiencing COVID symptoms, including diarrhea. […] Store food properly: Store food at the correct temperatures, and cook all foods until they reach the recommended temperatures. Dont take chances by consuming foods or drinks past their expiration dates. […] Watch what you drink when you travel: Dont drink untreated water when you travel. Avoid tap water, ice cubes or brushing your teeth with tap water. Steer clear of unpasteurized milk or juice products. Pasteurization is a process that kills germs in certain drinks. When in doubt, drink bottled water or something thats been boiled first (coffee or tea). […] Watch what you eat when you travel: Avoid raw or undercooked meats (and shellfish), as well as raw fruits and vegetables. Fruits and veggies are usually healthy options, but the skin may contain contaminants that can make you sick.

• #9 Diarrhea Prevention: 7 Ways to Prevent Diarrhea

  https://www.webmd.com/digestive-disorders/understanding-diarrhea-prevention

  Though some types of diarrhea, such as those due to other medical conditions, are unavoidable, infectious diarrhea can be prevented. […] The most important way to avoid diarrhea is to avoid coming into contact with infectious agents that can cause it. This means that good hand washing and hygiene are very important. […] Also, if you travel to developing countries, you should take the following precautions: Drink only bottled water, even for tooth brushing. Avoid eating food from street vendors. Avoid ice made with tap water. Eat only those fruits or vegetables that are cooked or can be peeled. Be sure that all foods you eat are thoroughly cooked and served steaming hot. Pre-packaged food is usually safe to consume (check expiration date). Never eat raw or undercooked meat or seafood. Obtain hepatitis A and typhoid vaccinations prior to travel, if indicated for that region.

• #10 Prevention of Diarrhea: Hygiene and Lifestyle Practices

  https://www.healthline.com/health/diarrhea/prevention-of-diarrhea

  Preventing diarrhea includes properly preparing food, protecting yourself against infections, and following some proper hygiene habits in your daily life. […] Food poisoning happens when you ingest bacteria-contaminated foods or other foodborne toxins, such as fungi, that disrupt the healthy bacteria in your gut. This can affect your digestion and result in diarrhea. […] Be sure to cook food thoroughly, especially meats like beef and chicken and fish, to kill any foodborne bacteria that can also lead to diarrhea. […] Travelers diarrhea happens when you eat food or drink water contaminated with bacteria, viruses, or parasites. It is common in areas with different sanitation practices than what youre used to. […] To help prevent the spread of viral or bacterial infections, wash your hands before and after you shake hands, share objects or uncooked food, and use the bathroom.

• #11 Prevention and Treatment of Traveler’s Diarrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/0701/p119.html

  Traveler’s diarrhea can usually be avoided by carefully selecting foods and beverages. […] It is important to realize, however, that traveler’s diarrhea can be minimized by education about ways to prevent the disease. Physicians can do a great deal to ensure that their patients have a safe and enjoyable trip abroad. […] Traveler’s diarrhea is fundamentally a sanitation failure, leading to bacterial contamination of food and water. It is best prevented through proper sewage treatment and water disinfection. In the absence of these amenities, the next best option is for the educated traveler to take precautions to prevent the disease. […] Preventive measures include not drinking tap water, not using ice in beverages (even alcoholic drinks), not eating salads and other forms of raw vegetables, not eating fruits that can’t be peeled on the spot and not eating mayonnaise, pastry icing, unpasteurized dairy products and undercooked shellfish.

• #12

  https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease

  Diarrhoeal disease is both preventable and treatable. […] A significant proportion of diarrhoeal disease can be prevented through safe drinking-water and adequate sanitation and hygiene. […] Interventions to prevent diarrhoea, including safe drinking-water, use of improved sanitation and hand washing with soap, can reduce disease risk. […] Key measures to prevent diarrhoea include: access to safe drinking-water, use of improved sanitation, hand washing with soap, exclusive breastfeeding for the first 6 months of life, good personal and food hygiene, health education about how infections spread, rotavirus vaccination. […] WHO works with Member States and other partners to promote national policies and investments that support case management of diarrhoea and its complications as well as increasing access to safe drinking-water and sanitation in developing countries. […] conduct research to develop and test new diarrhoea prevention and control strategies in this area.

• #13 Traveler’s diarrhea diet Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/nutrition/traveler-s-diarrhea-diet

  Traveler’s diarrhea causes loose, watery stools. People can get traveler’s diarrhea when they visit places where the water is not clean or the food is not handled safely. […] You can lower your risk of getting traveler’s diarrhea by avoiding water, ice, and food that may be contaminated. The goal of the traveler’s diarrhea diet is to make your symptoms better and prevent you from getting dehydrated. […] How to prevent traveler’s diarrhea: […] Do not use tap water to drink or brush your teeth. […] Drink only pasteurized milk. […] Do not eat raw fruits and vegetables unless you peel them. Wash all fruits and vegetables before eating them. […] Wash hands often. […] There is no vaccine against traveler’s diarrhea. […] Your health care provider may recommend medicines to help lower your chances of getting sick.

• #14 Traveler’s diarrhea diet – UF Health

  https://ufhealth.org/conditions-and-treatments/travelers-diarrhea-diet

  Bacteria, parasites, and other substances in the water and food can cause traveler’s diarrhea. […] You can lower your risk of getting traveler’s diarrhea by avoiding water, ice, and food that may be contaminated. The goal of the traveler’s diarrhea diet is to make your symptoms better and prevent you from getting dehydrated. […] How to prevent traveler’s diarrhea: […] Do not use tap water to drink or brush your teeth. […] Do not use ice made from tap water. […] Use only boiled water (boiled for at least 5 minutes) for mixing baby formula. […] Drink only pasteurized milk. […] Drink bottled drinks if the seal on the bottle hasn’t been broken. […] Eat hot, well-cooked foods. Heat kills the bacteria. […] There is no vaccine against traveler’s diarrhea. […] Your health care provider may recommend medicines to help lower your chances of getting sick.

• #15 Traveler’s Diarrhea Prophylaxis

  https://mobile.fpnotebook.com/GI/Prevent/TrvlrsDrhPrphylxs.htm

  Traveler’s Diarrhea Prophylaxis, Prophylaxis of Traveler’s Diarrhea, Prevention of Traveler’s Diarrhea, Traveler’s Diarrhea Prevention […] Rule 1: „Boil it, Cook it, Peel it or Forget it” […] Preparing your own food ensures safety (avoid food prepared by street vendors) […] Exposures to avoid: Avoid raw, unpeeled vegetables, lettucs, tomatoes […] Avoid pre-peeled fruit […] Avoid tap water or ice (Alcohol does not sterilize) […] Avoid uncooked meats and seafood […] Avoid unpasteurized dairy products (cream, milk, cheese) […] Avoid foods that are not steaming hot: Food should be heated above 65 degrees Celsius […] Food should be too hot to touch […] Patient to start prophylaxis with onset of Diarrhea […] Maximum duration of prophylaxis is 3 weeks […] Bismuth Subsalicylate (Pepto-Bismol) 2 tabs orally four times daily: Efficacy: 60% protection

• #16 Traveler’s Diarrhea – Harvard Health

  https://www.health.harvard.edu/a_to_z/travelers-diarrhea-a-to-z

  Traveler’s diarrhea is an infection of the intestines that affects up to 50% of people who visit the developing world. It comes from eating contaminated food or drinking contaminated water. […] Many cases of traveler’s diarrhea can be prevented. Keep the following rules in mind, even in expensive resorts and hotels: Alcohol does not sterilize water, so be cautious about contaminated water (including ice) used in mixed drinks. Carbonated beverages and bottled water are usually safe to drink, but don’t use ice, which could be contaminated. Drink from the bottle with a straw, rather than out of a glass. The glass may have been washed with contaminated water. Purify water by boiling it for at least three minutes or using a water purification system. Hot coffee and tea usually are usually safe to drink, but be sure the water has been boiled. Don’t eat fruits and vegetables unless they can be peeled, and peel them yourself to make sure that they are not contaminated after they are peeled. Avoid dairy products, unless you are sure they have been pasteurized, and avoid undercooked meat and fish. Wash your hands with the cleanest water available, or disinfect them with alcohol wipes before eating. You can decrease your chance of getting diarrhea by taking two tablets of bismuth subsalicylate (Pepto-Bismol) four times a day, although you shouldn’t do this for more than three weeks. […] Do not take antibiotics to prevent diarrhea unless your doctor tells you to. Antibiotics can have side effects, including sensitivity to sun, allergic reactions, and vaginal yeast infections.

• #17 Prevention and Treatment of Traveler’s Diarrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/0701/p119.html

  Active intervention involves boiling water for three to five minutes (depending on elevation), filtering water or using chlorine bleach (2 drops per quart) or tincture of iodine (5 drops per quart) in the water. […] Bismuth subsalicylate (Pepto-Bismol), in a dosage of two 262-mg tablets four times a day (taken with meals and in the evening) can prevent traveler’s diarrhea. It has been shown to provide a 65 percent protection rate. […] Compared with bismuth subsalicylate, antibiotic prophylaxis with trimethoprim-sulfamethoxazole (Bactrim DS), in a dosage of 160 mg/800 mg daily, or doxycycline (Vibramycin), in a dosage of 100 mg daily, has been found to provide even better results for up to three weeks. […] For instance, trimethoprim-sulfamethoxazole continues to be effective prophylaxis for summertime travel in inland Mexico, but it is unreliable in many other situations.

• #18

  https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=aa140669spec

  Traveller’s diarrhea is a common medical problem for people travelling from developed, industrialized countries to developing areas of the world. […] The best way to lower your risk of traveller’s diarrhea is to avoid food or water that may be contaminated. A good rule of thumb for food safety is, „If it’s not boiled, well-cooked, or peeled, don’t eat it.” […] Avoid drinking local water where you’re travelling. […] Water can be boiled, treated, or filtered to make it safe to drink. […] Good handwashing is important in preventing the spread of infectious diseases. Washing with treated water or using alcohol wipes or antibacterial gels to disinfect your hands are good ways to lower your risk of getting an infectious disease. […] Talk with your doctor or travel health professional about antibiotics you can carry with you on your trip and instructions on when to use them just in case you get diarrhea. […] Dukoral vaccine is a cholera vaccine. There is little proof that it helps prevent traveller’s diarrhea, so it is usually not recommended for travellers.

• #19 Traveler’s Diarrhea: Causes, Symptoms, and Prevention

  https://www.webmd.com/digestive-disorders/travelers-diarrhea

  You can take steps to prevent infection, such as making sure you cook all your foods and drink bottled water. […] You can’t always avoid traveler’s diarrhea, but you can reduce your risk by taking these steps: Drink only bottled water with unbroken seals, boiled tap water, and purified water. […] Bismuth subsalicylate (Pepto-Bismol) eases diarrhea and shortens the duration of your illness. […] This medication can also help prevent traveler’s diarrhea if you take it regularly before and during your travels. […] The most important treatment is staying hydrated and replacing minerals lost through diarrhea. […] If you can’t find the powder, you can make your own with: 3/4 teaspoon table salt, 2 tablespoons sugar, 1 quart bottled or boiled water. […] Seek medical help for traveler’s diarrhea if: Diarrhea is severe, bloody, or does not resolve within a few days. […] You can also use water treatment tablets containing chlorine dioxide or iodine.

• #20 Travelers’ Diarrhea | Yellow Book | CDC

  https://wwwnc.cdc.gov/travel/yellowbook/2024/preparing/travelers-diarrhea

  Healthcare professionals should advise on food safety and options for medications to prevent and treat travelers diarrhea. […] Traveler adherence to recommended approaches can, however, help reducealthough never fully eliminatethe risk for illness. These recommendations include making careful food and beverage choices, using agents other than antimicrobial medications for prophylaxis, and carefully washing hands with soap whenever available. […] Where provided, effective food-handling courses have been shown to decrease the risk for TD. […] The primary agent studied for prevention of TD, other than antibiotics, is bismuth subsalicylate (BSS). Studies from Mexico have shown that this agent reduces the incidence of TD by approximately 50%. […] Probiotics (e.g., Lactobacillus GG, Saccharomyces boulardii) have been studied in small numbers of people as TD prevention, but results are inconclusive, partly because standardized preparations of these bacteria are not reliably available.

• #21 Prevention and Treatment of Traveler’s Diarrhea | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/0701/p119.html

  Active intervention involves boiling water for three to five minutes (depending on elevation), filtering water or using chlorine bleach (2 drops per quart) or tincture of iodine (5 drops per quart) in the water. […] Bismuth subsalicylate (Pepto-Bismol), in a dosage of two 262-mg tablets four times a day (taken with meals and in the evening) can prevent traveler’s diarrhea. It has been shown to provide a 65 percent protection rate. […] Compared with bismuth subsalicylate, antibiotic prophylaxis with trimethoprim-sulfamethoxazole (Bactrim DS), in a dosage of 160 mg/800 mg daily, or doxycycline (Vibramycin), in a dosage of 100 mg daily, has been found to provide even better results for up to three weeks. […] For instance, trimethoprim-sulfamethoxazole continues to be effective prophylaxis for summertime travel in inland Mexico, but it is unreliable in many other situations.

• #22 New Guideline for Prevention and Management of Acute Diarrhealogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na41553/2016/06/16/new-guideline-prevention-and-management-acute-diarrhea

  Recommendations include those on preventing traveler’s diarrhea, which patients often ask about. […] For prophylaxis of TD, consider bismuth subsalicylate two tablets (2.1 g) four times daily at meals and bedtime to provide 60% risk reduction for trips up to 2 weeks but usually not for longer trips; lower doses are associated with reduced protection. […] Antibiotic prophylaxis for TD is recommended, but only in high-risk groups and for short-term use. This limited role for chemoprophylaxis is being reevaluated with increasing awareness of the high frequency and impact of postinfectious irritable bowel syndrome and the availability of rifaximin, which has desirable features and safety profile compared with quinolones for prophylaxis.

• #23 Traveler’s diarrhea diet – UF Health

  https://ufhealth.org/conditions-and-treatments/travelers-diarrhea-diet

  Taking 2 tablets of Pepto-Bismol 4 times a day before you travel and while you are traveling can help prevent diarrhea. […] Most people do not need to take antibiotics every day to prevent diarrhea while traveling. […] If you have diarrhea, follow these tips to help you feel better: […] Drink 8 to 10 glasses of clear fluids every day. Water or an oral rehydration solution is best. […] Get medical help right away if you or your child has symptoms of severe dehydration, or if you have a fever or bloody stools.

• #24 Approach to Treatment and Prevention of Traveler’s Diarrhea

  https://www.uspharmacist.com/article/approach-to-treatment-and-prevention-of-travelers-diarrhea

  Hand washing has been shown to reduce the incidence of diarrhea by up to 30% in community settings. […] Travelers should routinely wash their hands using soap and water while preparing food, before eating, and after using the toilet. […] Bismuth subsalicylate (BSS), the active ingredient in Pepto-Bismol, has been shown to be effective in the prevention of TD. […] To date, the safety of BSS use beyond 3 weeks has not been established. […] Although prophylactic antibiotics have been shown to be effective for TD, they are not recommended in most situations because of the risk of adverse reactions and the risk of antibiotic resistance should a serious infection occur. […] Ciprofloxacin and rifaximina nonabsorbed antibiotic that achieves high concentrations in the intestine can prevent TD, with efficacy rates of 70% to 90%. […] In most cases, TD is acquired primarily through the consumption of contaminated food or water. […] TD can be prevented with proper education and may be treated with OTC products and prescription antibiotics.

• #25 Approach to Treatment and Prevention of Traveler’s Diarrhea

  https://www.uspharmacist.com/article/approach-to-treatment-and-prevention-of-travelers-diarrhea

  Hand washing has been shown to reduce the incidence of diarrhea by up to 30% in community settings. […] Travelers should routinely wash their hands using soap and water while preparing food, before eating, and after using the toilet. […] Bismuth subsalicylate (BSS), the active ingredient in Pepto-Bismol, has been shown to be effective in the prevention of TD. […] To date, the safety of BSS use beyond 3 weeks has not been established. […] Although prophylactic antibiotics have been shown to be effective for TD, they are not recommended in most situations because of the risk of adverse reactions and the risk of antibiotic resistance should a serious infection occur. […] Ciprofloxacin and rifaximina nonabsorbed antibiotic that achieves high concentrations in the intestine can prevent TD, with efficacy rates of 70% to 90%. […] In most cases, TD is acquired primarily through the consumption of contaminated food or water. […] TD can be prevented with proper education and may be treated with OTC products and prescription antibiotics.

• #26 Travelers’ Diarrhea: Prevention, Treatment, and Posttrip Evaluation | MDedge

  https://blogs.the-hospitalist.org/content/travelers-diarrhea-prevention-treatment-and-posttrip-evaluation

  There is no consensus on recommending antibiotic chemoprophylaxis against TD. […] Even opponents of antibiotic chemoprophylaxis grant that it is probably warranted for two groups of travelers. The first is those whose trip schedule is of such importance that any deviation would be intolerable. The second is travelers with comorbidities that would render them at high risk for serious inconvenience or illness if they developed TD. […] If you prescribe an antibiotic prophylactically, consider daily doses of a fluoroquinolone (eg, ciprofloxacin 500 mg orally once daily, not twice daily as for treatment) or rifaximin 200 mg orally once or twice a day, for no longer than two to three weeks. […] Bismuth subsalicylate has reduced the incidence of TD from 40% to just 14% when taken in doses of two chewable tablets or 60 mL of liquid four times daily.

• #27 Travelers’ Diarrhea | Yellow Book | CDC

  https://wwwnc.cdc.gov/travel/yellowbook/2024/preparing/travelers-diarrhea

  Older controlled studies showed that use of antibiotics reduced diarrhea attack rates by 90%. […] Prophylactic antibiotics might rarely be considered for short-term travelers who are high-risk hosts (e.g., immunocompromised people or people who have significant medical comorbidities). […] Prophylactic antibiotics afford no protection against nonbacterial pathogens and can remove normally protective microflora from the bowel, increasing the risk for acquisition of resistant bacterial pathogens. […] Travelers can become colonized with extended-spectrum beta lactamase-producing enterobacteriaceae (ESBL-PE), a risk that is increased by exposure to antibiotics while abroad.

• #28 Travelers’ Diarrhea | Yellow Book | CDC

  https://www.cdc.gov/yellow-book/hcp/preparing-international-travelers/travelers-diarrhea.html

  Older controlled studies showed that use of antibiotics reduced diarrhea attack rates by 90%. […] Prophylactic antibiotics are not recommended for most travelers. Prophylactic antibiotics afford no protection against nonbacterial pathogens and can remove normally protective microflora from the bowel, increasing the risk for acquisition of resistant bacterial pathogens. […] Travelers can become colonized with extended-spectrum beta lactamase-producing enterobacteriaceae (ESBL-PE), a risk that is increased by exposure to antibiotics while abroad.

• #29

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5731448/

  Mild (acute): diarrhea that is tolerable, is not distressing, and does not interfere with planned activities. […] Moderate (acute): diarrhea that is distressing or interferes with planned activities. […] Severe (acute): diarrhea that is incapacitating or completely prevents planned activities; all dysentery (passage of grossly bloody stools) is considered severe. […] Persistent: diarrhea lasting 2 weeks. […] Antimicrobial prophylaxis should not be used routinely in travelers (Strong recommendation, low/very low level of evidence). […] Antimicrobial prophylaxis should be considered for travelers at high risk of health-related complications of travelers diarrhea (Strong recommendation, low/very low level of evidence). […] Bismuth subsalicylate (BSS) may be considered for any traveler to prevent travelers diarrhea (Strong recommendation, high level of evidence).

• #30 Travelers’ Diarrhea: New Guidelines for Prevention and Treatment

  https://www.medscape.com/viewarticle/887515

  Travelers’ diarrhea is the most predictable travel-related illness and affects 30%-70% of international travelers, depending on destination, season of travel, and other factors. […] Antimicrobial prophylaxis should not be used routinely in travelers (strong recommendation, low/very low level of evidence). […] Antimicrobial prophylaxis should be considered for travelers at high risk for health-related complications of travelers’ diarrhea (strong recommendation, low/very low level of evidence). […] Bismuth subsalicylate (BSS) may be considered for any traveler to prevent travelers’ diarrhea (strong recommendation, high level of evidence). […] When antimicrobial prophylaxis is indicated, rifaximin is recommended for all regions (strong recommendation, moderate level of evidence). […] Fluoroquinolones are not recommended for prophylaxis of travelers’ diarrhea (strong recommendation, low/very low level of evidence).

• #31 A review of antibiotic prophylaxis for traveler’s diarrhea: past to present | Tropical Diseases, Travel Medicine and Vaccines | Full Text

  https://tdtmvjournal.biomedcentral.com/articles/10.1186/s40794-018-0074-4

  As there is rapid increase in international travel to tropical and subtropical countries, there will likely be more people exposed to diarrheal pathogens in these moderate to high risk areas and subsequent increased concern for travelers diarrhea. […] The use of antibiotic prophylaxis to prevent TD has been reported among travelers for several years. […] The use of antibiotic prophylaxis for TD prevention in travelers is still controversial, mainly because of difficulties balancing the risks and benefits. […] It has been reported previously that approximately 15% of travelers take antibiotics to prevent TD. […] Therefore, the use of antibiotic prophylaxis for travelers could be considered, to decrease the pathogen burden and prevent long-term morbidity. […] Current recommendations suggest that antibiotic prophylaxis for TD may be prescribed selectively in some travelers, especially in high-risk short-term travelers.

• #32 Traveler’s Diarrhea – Gastrointestinal Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/gastrointestinal-disorders/gastroenteritis/traveler-s-diarrhea

  Travelers should dine at restaurants with a reputation for safety and avoid foods and beverages from street vendors. They should consume only cooked foods that are still steaming hot, fruit that can be peeled, and carbonated beverages without ice served in sealed bottles (bottles of noncarbonated beverages can contain tap water added by unscrupulous vendors); uncooked vegetables (particularly including salsa left out on the table) should be avoided. Buffets and fast food restaurants pose an increased risk. […] Some patients may require prophylaxis if they have underlying medical conditions that make them particularly susceptible to the consequences of travelers diarrhea. This includes patients with immunocompromise including inflammatory bowel disease or HIV, recipients of organ transplants, and patients with severe cardiovascular or kidney disease. The nonabsorbable antibiotic rifaximin can be used for prophylaxis in these patients. The dosage of rifaximin is 200 mg orally 3 times a day. Previously, fluoroquinolones were prescribed; however, adverse effects, including tendon rupture and peripheral neuropathy, limited their use. Some travelers may consider the nonantibiotic bismuth subsalicylate as an alternative for prophylaxis. […] Prevention is the best measure and involves careful selection of foods and beverages; prophylactic antibiotics are not routinely used except for patients with immunocompromise.

• #33

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5731448/

  When antibiotic prophylaxis is indicated, rifaximin is recommended (Strong recommendation, moderate level of evidence). […] Fluoroquinolones are not recommended for prophylaxis of travelers diarrhea (Strong recommendation, low/very low level of evidence). […] Antibiotic treatment is not recommended in patients with mild travelers diarrhea (Strong recommendation, moderate level of evidence). […] Loperamide or BSS may be considered in the treatment of mild travelers diarrhea (Strong recommendation, moderate level of evidence). […] Antibiotics may be used to treat moderate travelers diarrhea (Weak recommendation, moderate level of evidence). […] Fluoroquinolones may be used to treat moderate travelers diarrhea (Strong recommendation, moderate level of evidence). […] Azithromycin may be used to treat moderate travelers diarrhea (Strong recommendation, high level of evidence).

• #34 Travelers’ Diarrhea: New Guidelines for Prevention and Treatment

  https://www.medscape.com/viewarticle/887515

  Travelers’ diarrhea is the most predictable travel-related illness and affects 30%-70% of international travelers, depending on destination, season of travel, and other factors. […] Antimicrobial prophylaxis should not be used routinely in travelers (strong recommendation, low/very low level of evidence). […] Antimicrobial prophylaxis should be considered for travelers at high risk for health-related complications of travelers’ diarrhea (strong recommendation, low/very low level of evidence). […] Bismuth subsalicylate (BSS) may be considered for any traveler to prevent travelers’ diarrhea (strong recommendation, high level of evidence). […] When antimicrobial prophylaxis is indicated, rifaximin is recommended for all regions (strong recommendation, moderate level of evidence). […] Fluoroquinolones are not recommended for prophylaxis of travelers’ diarrhea (strong recommendation, low/very low level of evidence).

• #35 Prophylaxis of Traveler’s Diarrhea Using Rifaximinlogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/id200506240000003/2005/06/24/prophylaxis-traveler-s-diarrhea-using-rifaximin

  Rifaximin, a nonabsorbable inhibitor of bacterial RNA synthesis, is approved for treating traveler’s diarrhea. To test its effectiveness in preventing such illness, investigators conducted a randomized, double-blind trial, partly industry-funded, in 210 U.S. students who were traveling to Mexico. Participants received either rifaximin (200 mg 1, 2, or 3 times daily) or placebo (3 times daily) for 2 weeks. They were monitored daily for 3 weeks for incidence of traveler’s diarrhea (defined as 3 or more unformed stools per day, coupled with classic signs and symptoms of enteric infection) and for 5 weeks for drug side effects. Active diarrhea was treated with other antimicrobials. […] The three rifaximin regimens were similarly effective in preventing diarrhea (mean incidence, 14.7%) compared with placebo (53.7%).

• #36 A review of antibiotic prophylaxis for traveler’s diarrhea: past to present | Tropical Diseases, Travel Medicine and Vaccines | Full Text

  https://tdtmvjournal.biomedcentral.com/articles/10.1186/s40794-018-0074-4

  Rifaximin is preferred to other antibiotics because of its poor absorption, reducing the risk of development of resistance in extraintestinal bacteria. […] Prophylactic antibiotic prescribing for TD should always include an individual risk assessment, including type of traveler, their destination, travel purpose, itineraries, drug side effects, and cost-benefit analysis.

• #37 Travelers’ diarrhea: antimicrobial therapy and chemoprevention | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/ncpgasthep0142

  The use of preventive measures and self-treatment for travelers’ diarrhea is routine in regions where the occurrence of diarrhea is predictably high. […] Although systemic antibacterial drugs are effective in preventing diarrhea, their use is not routinely recommended because of side effects and their importance as a therapy for extra-intestinal infections. […] Minimally absorbed (0.4%) rifaximin can effectively reduce the occurrence of travelers’ diarrhea without side effects. […] All people who travel to high-risk areas should take curative antimicrobial agents with them for self-treatment of illness: rifaximin 200 mg three times a day for 3 days, or an absorbable agent such as a fluoroquinolone or azithromycin taken in a single dose initially, with the need for a second or third dose determined by clinical response. […] In the future, the ability to evaluate the genetic risk of illness acquisition might allow person-specific recommendations to be made.

• #38

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5731448/

  When antibiotic prophylaxis is indicated, rifaximin is recommended (Strong recommendation, moderate level of evidence). […] Fluoroquinolones are not recommended for prophylaxis of travelers diarrhea (Strong recommendation, low/very low level of evidence). […] Antibiotic treatment is not recommended in patients with mild travelers diarrhea (Strong recommendation, moderate level of evidence). […] Loperamide or BSS may be considered in the treatment of mild travelers diarrhea (Strong recommendation, moderate level of evidence). […] Antibiotics may be used to treat moderate travelers diarrhea (Weak recommendation, moderate level of evidence). […] Fluoroquinolones may be used to treat moderate travelers diarrhea (Strong recommendation, moderate level of evidence). […] Azithromycin may be used to treat moderate travelers diarrhea (Strong recommendation, high level of evidence).

• #39 Traveler’s Diarrhea – Gastrointestinal Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/gastrointestinal-disorders/gastroenteritis/traveler-s-diarrhea

  Travelers should dine at restaurants with a reputation for safety and avoid foods and beverages from street vendors. They should consume only cooked foods that are still steaming hot, fruit that can be peeled, and carbonated beverages without ice served in sealed bottles (bottles of noncarbonated beverages can contain tap water added by unscrupulous vendors); uncooked vegetables (particularly including salsa left out on the table) should be avoided. Buffets and fast food restaurants pose an increased risk. […] Some patients may require prophylaxis if they have underlying medical conditions that make them particularly susceptible to the consequences of travelers diarrhea. This includes patients with immunocompromise including inflammatory bowel disease or HIV, recipients of organ transplants, and patients with severe cardiovascular or kidney disease. The nonabsorbable antibiotic rifaximin can be used for prophylaxis in these patients. The dosage of rifaximin is 200 mg orally 3 times a day. Previously, fluoroquinolones were prescribed; however, adverse effects, including tendon rupture and peripheral neuropathy, limited their use. Some travelers may consider the nonantibiotic bismuth subsalicylate as an alternative for prophylaxis. […] Prevention is the best measure and involves careful selection of foods and beverages; prophylactic antibiotics are not routinely used except for patients with immunocompromise.

• #40 Travelers’ Diarrhea | Yellow Book | CDC

  https://wwwnc.cdc.gov/travel/yellowbook/2024/preparing/travelers-diarrhea

  Healthcare professionals should advise on food safety and options for medications to prevent and treat travelers diarrhea. […] Traveler adherence to recommended approaches can, however, help reducealthough never fully eliminatethe risk for illness. These recommendations include making careful food and beverage choices, using agents other than antimicrobial medications for prophylaxis, and carefully washing hands with soap whenever available. […] Where provided, effective food-handling courses have been shown to decrease the risk for TD. […] The primary agent studied for prevention of TD, other than antibiotics, is bismuth subsalicylate (BSS). Studies from Mexico have shown that this agent reduces the incidence of TD by approximately 50%. […] Probiotics (e.g., Lactobacillus GG, Saccharomyces boulardii) have been studied in small numbers of people as TD prevention, but results are inconclusive, partly because standardized preparations of these bacteria are not reliably available.

• #41

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5731448/

  Microbiologic testing is recommended in returning travelers with severe or persistent symptoms or in those who fail empiric therapy (Strong recommendation, low/very low level of evidence). […] Molecular testing, aimed at a broad range of clinically relevant pathogens, is preferred when rapid results are clinically important or non-molecular tests have failed to establish a diagnosis (ungraded). […] There is insufficient evidence to recommend the use of commercially available prebiotics or probiotics to prevent or treat travelers diarrhea. […] Studies are needed on changes in the gut microbiome in travelers with and without diarrhea to clarify the benefits and harms of current and novel preventive, diagnostic, and therapeutic approaches. […] There is an incrementally increasing association between travel, travelers diarrhea, and antibiotic use with the acquisition of multidrug-resistant bacteria. Pre-travel counseling should include information about this risk, balanced against the benefits of antibiotic use.

• #42

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5731448/

  Microbiologic testing is recommended in returning travelers with severe or persistent symptoms or in those who fail empiric therapy (Strong recommendation, low/very low level of evidence). […] Molecular testing, aimed at a broad range of clinically relevant pathogens, is preferred when rapid results are clinically important or non-molecular tests have failed to establish a diagnosis (ungraded). […] There is insufficient evidence to recommend the use of commercially available prebiotics or probiotics to prevent or treat travelers diarrhea. […] Studies are needed on changes in the gut microbiome in travelers with and without diarrhea to clarify the benefits and harms of current and novel preventive, diagnostic, and therapeutic approaches. […] There is an incrementally increasing association between travel, travelers diarrhea, and antibiotic use with the acquisition of multidrug-resistant bacteria. Pre-travel counseling should include information about this risk, balanced against the benefits of antibiotic use.

• #43 Travelers’ Diarrhea: Prevention, Treatment, and Posttrip Evaluation | MDedge

  https://blogs.the-hospitalist.org/content/travelers-diarrhea-prevention-treatment-and-posttrip-evaluation

  Probiotics such as Lactobacillus and Saccharomyces are among the other nonantimicrobial chemoprophylaxis agents. […] Natural immunity to E coli gastrointestinal infection among indigenous people in less developed countries has raised the possibility of a role for vaccines in preventing TD. Some strains of ETEC produce a heat-labile toxin (LT) that bears significant resemblance to the toxin produced by Vibrio cholerae. Therefore, the oral cholera vaccine has been marketed outside the United States for the prevention of TD.

• #44 Probiotics for the prevention of antibiotic-associated diarrhea in children | Cochrane

  https://www.cochrane.org/CD004827/IBD_probiotics-prevention-antibiotic-associated-diarrhea-children

  Probiotics may restore the natural balance of bacteria in the intestinal tract. […] The researchers investigated whether probiotics prevent AAD in children receiving antibiotic therapy and whether probiotics causes any harms (side effects). […] Analyses showed that probiotics are effective for preventing AAD. […] For every 9 children treated, probiotics will prevent one case of diarrhea. […] Evidence suggested that probiotics are effective for a moderate reduction in duration of diarrhea (almost one day). […] The overall evidence suggests a moderate protective effect of probiotics for preventing AAD (NNTB 9, 95% CI 7 to 13). […] Based on high-dose probiotics, the NNTB to prevent one case of diarrhea is 6 (95% CI 5 to 9). […] Evidence also suggests that probiotics may moderately reduce the duration of diarrhea, a reduction by almost one day. […] Adverse event rates were low and no serious adverse events were attributable to probiotics. […] Common adverse events included rash, nausea, gas, flatulence, abdominal bloating, and constipation. […] Probiotics reducing diarrhea duration by almost one day.

• #45 Diarrhea Treatment & Management: Medical Care, Further Care, Consultations

  https://emedicine.medscape.com/article/928598-treatment

  Vaccines are indicated for persons with high risk of exposure to some pathogens. […] In February 2006, the United States Food and Drug Administration (FDA) approved an oral vaccine for rotavirus (RotaTeq). […] In April 2008, the FDA approved Rotarix, another oral vaccine, for prevention of rotavirus gastroenteritis. […] A Cochrane Database review evaluated the results of 43 trials with 190,551 participants comparing rotavirus vaccines, both the monovalent and pentavalent types (RV1 and RV5), with placebo. Both vaccines were found to be effective in preventing rotavirus diarrhea. […] The Salmonella typhi vaccine is recommended for travelers to countries with a high risk of this infection, persons with intimate exposure to a documented typhoid fever carrier, and workers with frequent exposure to this bacteria.

• #46 Acute Diarrhea in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0201/p180.html

  Prevention of acute diarrhea is promoted through adequate hand washing, safe food preparation, access to clean water, and vaccinations. […] Good hygiene, hand washing, safe food preparation, and access to clean water are key factors in preventing diarrheal illness. […] Public health interventions to promote hand washing alone can reduce the incidence of diarrhea by about one-third. […] Vaccine development remains a high priority for disease prevention, particularly for those in the developing world. Effective and safe vaccines exist for rotavirus, typhoid fever, and cholera, and are under investigation for Campylobacter, enterotoxigenic E. coli, and Shigella infections.

• #47 Prevention and Self-Treatment of Traveler’s Diarrhea

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1539099/

  Of the millions who travel from the industrialized world to developing countries every year, between 20% and 50% will develop at least one episode of diarrhea, making it the most common medical ailment afflicting travelers. […] Precautions can be taken to minimize the risk of developing traveler’s diarrhea, either through avoidance of potentially contaminated food or drink or through various prophylactic measures, including both nonpharmacological and antimicrobial strategies. […] In the future, vaccinesseveral of which are in the advanced stages of clinical testingmay be added to the list of prophylactic measures. […] Prevention of traveler’s diarrhea falls into four broad categories: immunization, avoidance, nonpharmacological therapy, and antibiotic prophylaxis. […] A live-attenuated oral cholera vaccine (Mutacol, Orochol) has been shown to have protective efficacy as high as 90% when recipients were challenged with Vibrio cholerae within 3 months of vaccination.

• #48 Prevention of Diarrhea: Hygiene and Lifestyle Practices

  https://www.healthline.com/health/diarrhea/prevention-of-diarrhea

  Rotavirus happens most commonly to children under 5 years old. Children who are vaccinated against rotavirus are much less likely to get an infection and have diarrhea as a result. […] Diarrhea is also known to be a symptom of COVID-19. Vaccines for COVID-19 can help prevent diarrhea and other complications of this disease. […] Bismuth subsalicylate (Pepto-Bismol) is a popular preventive medication for diarrhea. Additionally, loperamide (Imodium) is often used as a general treatment until the cause of diarrhea is identified. […] Here are some general tips to help prevent diarrhea: Drink 913 cups of water every day. Adjust your water intake based on your level of physical activity. […] Diarrhea is common, but it can be prevented through diet and lifestyle changes.

• #49 Prevention and Self-Treatment of Traveler’s Diarrhea

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1539099/

  Of the millions who travel from the industrialized world to developing countries every year, between 20% and 50% will develop at least one episode of diarrhea, making it the most common medical ailment afflicting travelers. […] Precautions can be taken to minimize the risk of developing traveler’s diarrhea, either through avoidance of potentially contaminated food or drink or through various prophylactic measures, including both nonpharmacological and antimicrobial strategies. […] In the future, vaccinesseveral of which are in the advanced stages of clinical testingmay be added to the list of prophylactic measures. […] Prevention of traveler’s diarrhea falls into four broad categories: immunization, avoidance, nonpharmacological therapy, and antibiotic prophylaxis. […] A live-attenuated oral cholera vaccine (Mutacol, Orochol) has been shown to have protective efficacy as high as 90% when recipients were challenged with Vibrio cholerae within 3 months of vaccination.

• #50 Prevention and Self-Treatment of Traveler’s Diarrhea

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1539099/

  Of the millions who travel from the industrialized world to developing countries every year, between 20% and 50% will develop at least one episode of diarrhea, making it the most common medical ailment afflicting travelers. […] Precautions can be taken to minimize the risk of developing traveler’s diarrhea, either through avoidance of potentially contaminated food or drink or through various prophylactic measures, including both nonpharmacological and antimicrobial strategies. […] In the future, vaccinesseveral of which are in the advanced stages of clinical testingmay be added to the list of prophylactic measures. […] Prevention of traveler’s diarrhea falls into four broad categories: immunization, avoidance, nonpharmacological therapy, and antibiotic prophylaxis. […] A live-attenuated oral cholera vaccine (Mutacol, Orochol) has been shown to have protective efficacy as high as 90% when recipients were challenged with Vibrio cholerae within 3 months of vaccination.

• #51

  https://step1.medbullets.com/evidence/10414633

  Common pathogens in traveler’s diarrhea include enterotoxigenic Escherichia coli, Campylobacter, Shigella, Salmonella, Yersinia and many other species. […] Fortunately, traveler’s diarrhea can usually be avoided by carefully selecting foods and beverages. […] Although drug prophylaxis is now discouraged, treatment with loperamide (in the absence of dysentery) and a fluoroquinolone, such as ciprofloxacin (500 mg twice daily for one to three days), is usually safe and effective in adults with traveler’s diarrhea. […] Nonabsorbable antibiotics, immunoprophylaxis with vaccines and biotherapeutic microbes that inhibit pathogen infection may eventually supplant antibiotic treatment. […] Ultimately, the best solution is improvements in sanitary engineering and the development of safe water supplies.

• #52 Prevention and Treatment for Diarrheal Disease? | Stop The Cycle | Defeat DD

  https://report.defeatdd.org/solutions/

  Proven solutions exist to prevent and treat diarrhea when infants and young children get sick. […] In settings where medical care can be difficult to access, prevention through vaccination is the best way to protect children. […] Using safe water, properly disposing of human waste, and handwashing with soap help prevent diarrhea. […] Breast milk is the ideal nourishment for infants, protecting against infections and enabling them to recover more quickly from illness. Proper infant and young child nutrition fortifies the immune system against infectious diseases and promotes healthy, long-term growth and development. […] Oral rehydration solution (ORS) is a simple, lifesaving mixture of sugar, water, and salt that replenishes fluids and electrolytes. Zinc reduces the severity and duration of diarrhea infections. It can also prevent future episodes.

• #53

  https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease

  Diarrhoeal disease is both preventable and treatable. […] A significant proportion of diarrhoeal disease can be prevented through safe drinking-water and adequate sanitation and hygiene. […] Interventions to prevent diarrhoea, including safe drinking-water, use of improved sanitation and hand washing with soap, can reduce disease risk. […] Key measures to prevent diarrhoea include: access to safe drinking-water, use of improved sanitation, hand washing with soap, exclusive breastfeeding for the first 6 months of life, good personal and food hygiene, health education about how infections spread, rotavirus vaccination. […] WHO works with Member States and other partners to promote national policies and investments that support case management of diarrhoea and its complications as well as increasing access to safe drinking-water and sanitation in developing countries. […] conduct research to develop and test new diarrhoea prevention and control strategies in this area.

• #54 Dehydration and diarrhea in children: Prevention and treatment | Caring for kids

  https://caringforkids.cps.ca/handouts/health-conditions-and-treatments/dehydration_and_diarrhea

  Proper handwashing and safe food handling are the best ways to prevent the spread of germs that cause diarrhea. […] Oral rehydration solutions can be used to: keep children well hydrated when they have significant amounts of diarrhea. […] Do not give your child sugary drinks like fruit juice or sweetened fruit drinks, carbonated drinks (pop/soda), sweetened tea, broth or rice water. These do not have the right amounts of water, salts and sugar and can make your child’s diarrhea worse. […] If your child is having frequent diarrhea, make sure they are drinking an oral rehydration solution (not just plain water) and eating food. Bland foods with complex carbohydrates, lean meats, and fruits and vegetables are encouraged. Drinking only water may lead to low blood sugar or low sodium levels in your child’s blood.

• #55

  https://link.springer.com/article/10.1007/s40475-018-0134-x

  Provide an overview about childhood diarrhea burden and prevention interventions with demonstrated impact in reducing disease risk. […] Available rotavirus vaccines have demonstrated to significantly decrease diarrhea hospital admissions and mortality. WASH interventions, especially point of use water safety improvements and handwashing, are effective in decreasing diarrhea burden. Early and exclusive breastfeeding prevents early childhood diarrhea. […] Vaccines, water, sanitation, and hygiene (WASH) and breastfeeding are effective and affordable interventions. Future research should determine the effectiveness of combining these interventions and address problems in implementation and integration of interventions. […] This metaanalysis evaluates the impact of breastfeeding on prevention of diarrhea and estimates the potential impact of widespread implementation of good breastfeeding practices. […] Exclusive breast feeding in early infancy reduces the risk of inpatient admission for diarrhea and suspected pneumonia in rural Vietnam: a prospective cohort study. […] Breastfeeding and protection against diarrhea: an integrative review of literature.

• #56 Traveler’s diarrhea diet Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/nutrition/traveler-s-diarrhea-diet

  Traveler’s diarrhea causes loose, watery stools. People can get traveler’s diarrhea when they visit places where the water is not clean or the food is not handled safely. […] You can lower your risk of getting traveler’s diarrhea by avoiding water, ice, and food that may be contaminated. The goal of the traveler’s diarrhea diet is to make your symptoms better and prevent you from getting dehydrated. […] How to prevent traveler’s diarrhea: […] Do not use tap water to drink or brush your teeth. […] Drink only pasteurized milk. […] Do not eat raw fruits and vegetables unless you peel them. Wash all fruits and vegetables before eating them. […] Wash hands often. […] There is no vaccine against traveler’s diarrhea. […] Your health care provider may recommend medicines to help lower your chances of getting sick.

• #57 Provider Guide: Prevention/Management of Irinotecan-Induced Diarrhea

  https://www.pogo.ca/satellite-manual/3-0-chemotherapy-administration/3-7-chemotherapy-quick-reference/3-7-2-provider-guide-prevention-and-management-of-irinotecan-induced-diarrhea/

  Irinotecan is a generally well-tolerated chemotherapy agent with increasing indications in pediatric oncology. One of its most important and often dose-limiting toxicities is diarrhea. This guide aims to assist providers in diarrhea prevention and management. […] Patients who have experienced significant diarrhea, colitis, abdominal pain or vomiting with past cycles of irinotecan may benefit from prophylaxis with cefixime. […] Antibiotic prophylaxis should be started in conversation with the patients specialized childhood cancer program. […] Family should be reminded to have loperamide on hand at home prior to beginning of irinotecan therapy and to start loperamide at the first episode of poorly formed or loose stools or earliest onset of bowel movements that are more frequent than usually expected.

• #58 Chemotherapy-Induced Diarrhea: Options for Treatment and Prevention

  https://jhoponline.com/issue-archive/2012-issues/december-2012-vol-3-no-4/15408:chemotherapy-unduced-diarrhea-options

  Objectives: To discuss the currently recommended treatment for CID, as well as other potential medications for the treatment and the prevention of CID. With the emergence of new therapeutic alternatives for severe CID, an update of the current treatment options is warranted. […] Through different mechanisms of action, medications such as corticosteroids, antibiotics, glutamine, palifermin, and activated charcoal have been studied for the prevention of CID. […] If diarrhea persists for more than 24 hours, high-dose loperamide (2 mg every 2 hours) is recognized as an appropriate therapeutic option in addition to initiating oral antibiotics for the prevention of infectious complications. […] The guidelines suggest the initiation of antibiotics for patients who are experiencing diarrhea for more than 24 hours for the prevention of septic complications.

• #59 Chemotherapy-Induced Diarrhea: Options for Treatment and Prevention

  https://jhoponline.com/issue-archive/2012-issues/december-2012-vol-3-no-4/15408:chemotherapy-unduced-diarrhea-options

  Budesonide prophylaxis has been studied in the prevention of severe colitis, a common adverse effect of therapy with ipilimumab. […] Glutamine supplementation may aid in protecting the gut mucosa from toxic chemotherapeutic agents. […] Probiotics, nonpathogenic microorganisms such as Lactobacillus rhamnosus, Lactobacillus acidophilus, and bifidobacterium, have been extensively studied in the prevention of diarrhea associated with irritable bowel syndrome and Crohns disease. […] Activated charcoal prophylaxis has shown decreased grades 3 and 4 diarrhea and loperamide use, while optimizing the amount of irinotecan that could be administered. […] Neomycin was also studied as a prophylactic regimen at a dose of 660 mg 3 times daily for 3 days, starting 2 days before receiving irinotecan.

• #60 Therapeutic Targeting of CPT-11 Induced Diarrhea: A Case for Prophylaxis

  https://www.eurekaselect.com/article/51993

  CPT-11 (irinotecan), a DNA topoisomerase I inhibitor is one of the main treatments for colorectal cancer. […] Many potential agents have been tested in preclinical and clinical studies to prevent or ameliorate CPT-11 induced late onset diarrhea. […] It is predicted that prophylaxis of CPT-11 induced diarrhea will reduce sub-therapeutic dosing as well as hospitalizations and will eventually lead to dose escalations resulting in better response rates. […] This article reviews various experimental agents and strategies employed to prevent this debilitating toxicity. […] Covered topics include schedule/dose modification, intestinal alkalization, structural/chemical modification, genetic testing, anti-diarrheal therapies, transporter (ABCB1, ABCC2, BCRP2) inhibitors, enzyme (-glucuronidase, UGT1A1, CYP3A4, carboxylesterase, COX-2) inducers and inhibitors, probiotics, antibiotics, adsorbing agents, cytokine and growth factor activators and inhibitors and other miscellaneous agents.

• #61

  https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease

  Diarrhoeal disease is both preventable and treatable. […] A significant proportion of diarrhoeal disease can be prevented through safe drinking-water and adequate sanitation and hygiene. […] Interventions to prevent diarrhoea, including safe drinking-water, use of improved sanitation and hand washing with soap, can reduce disease risk. […] Key measures to prevent diarrhoea include: access to safe drinking-water, use of improved sanitation, hand washing with soap, exclusive breastfeeding for the first 6 months of life, good personal and food hygiene, health education about how infections spread, rotavirus vaccination. […] WHO works with Member States and other partners to promote national policies and investments that support case management of diarrhoea and its complications as well as increasing access to safe drinking-water and sanitation in developing countries. […] conduct research to develop and test new diarrhoea prevention and control strategies in this area.

• #62 Scaling Up Diarrhea Prevention and Treatment Interventions: A Lives Saved Tool Analysis | PLOS Medicine

  https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000428

  Diarrhea remains a leading cause of mortality among young children in low- and middle-income countries. […] Although the evidence for individual diarrhea prevention and treatment interventions is solid, the effect a comprehensive scale-up effort would have on diarrhea mortality has not been estimated. […] We use the Lives Saved Tool (LiST) to estimate the potential lives saved if two scale-up scenarios for key diarrhea interventions (oral rehydration salts [ORS], zinc, antibiotics for dysentery, rotavirus vaccine, vitamin A supplementation, basic water, sanitation, hygiene, and breastfeeding) were implemented in the 68 high child mortality countries. […] Under the ambitious (feasible improvement in coverage of all interventions) and universal (assumes near 100% coverage of all interventions) scale-up scenarios, we demonstrate that diarrhea mortality can be reduced by 78% and 92%, respectively.

• #63 Prevention and Treatment for Diarrheal Disease? | Stop The Cycle | Defeat DD

  https://report.defeatdd.org/solutions/

  Combining both prevention and treatment solutions is the most effective way to defeat diarrhea and break the cycle of poor health and poverty for children, families, and communities. […] Diarrhea prevention and treatment solutions are complementary. […] Effectively implementing WASH solutions is critical to addressing the connection between malnutrition and diarrhea. […] By integrating prevention and treatment solutions, countries can maximize impact, increase efficiency, and reduce costs. […] Prevention is critical, especially for children without reliable access to care. […] Recognizing the urgency and potential of an integrated approach, WHO and UNICEF issued the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea (GAPPD) in 2013. […] Child health programs at every level must address diarrhea and pneumonia to make progress toward the Sustainable Development Goals (SDGs) and the United Nations Global Strategy for Womens and Childrens Health. […] This is a question of equity. Poor children in low-income countries are most at risk of death from pneumonia or diarrhea but much less likely to get the interventions they need.

• #64

  https://www.who.int/tools/elena/interventions/wsh-diarrhoea

  Diarrhoea remains a leading cause of death globally among children under five years of age. Diarrhoea contributes to nutritional deficiencies, reduced resistance to infections and impaired growth and development. Severe diarrhoea leads to fluid loss, and may be life-threatening, particularly in young children and people who are already malnourished or have impaired immunity. […] Diarrhoea mostly results from lack of safe drinking-water, adequate sanitation and hygiene. A number of interventions are effective in preventing diarrhoeal diseases, thereby positively impacting the nutritional status of those most vulnerable. These are: Access to safe drinking water (e.g. water safety planning (the management of water from the source to tap); household water treatment and safe storage); Access to improved sanitation facilities; Hand washing with soap at critical times (e.g. after toilet use and before the preparation of food). […] Hygiene promotion, along with access to safe drinking water and adequate sanitation should be accessible by all.

• #65 Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) – Defeat DD

  https://www.defeatdd.org/resources/reports/global-action-plan-prevention-and-control-pneumonia-and-diarrhoea-gappd/

  The Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD), a global plan published in 2013 by UNICEF and the World Health Organization (WHO), represents the first-ever simultaneous effort to protect children from pneumonia and diarrhoea, the two leading killer diseases of children less than five years old. […] Designed to inform global and national programs and policies, the GAPPD provides a framework to protect children, prevent disease, and treat children who do become sick using proven interventions that have already contributed to major reductions in child deaths. […] The NGO community issued a statement of support for the GAPPD and pledged to begin immediately working with national governments, donors, multilateral institutions, the private sector and other partners to make the global framework a reality in the countries and communities hardest hit. […] Advocacy toolkit for national efforts to promote GAPPD implementation.

• #66 Scaling Up Diarrhea Prevention and Treatment Interventions: A Lives Saved Tool Analysis | PLOS Medicine

  https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000428

  Diarrhea remains a leading cause of mortality among young children in low- and middle-income countries. […] Although the evidence for individual diarrhea prevention and treatment interventions is solid, the effect a comprehensive scale-up effort would have on diarrhea mortality has not been estimated. […] We use the Lives Saved Tool (LiST) to estimate the potential lives saved if two scale-up scenarios for key diarrhea interventions (oral rehydration salts [ORS], zinc, antibiotics for dysentery, rotavirus vaccine, vitamin A supplementation, basic water, sanitation, hygiene, and breastfeeding) were implemented in the 68 high child mortality countries. […] Under the ambitious (feasible improvement in coverage of all interventions) and universal (assumes near 100% coverage of all interventions) scale-up scenarios, we demonstrate that diarrhea mortality can be reduced by 78% and 92%, respectively.

• #67 Scaling Up Diarrhea Prevention and Treatment Interventions: A Lives Saved Tool Analysis | PLOS Medicine

  https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000428

  Using currently available interventions, we demonstrate that with improved coverage, diarrheal deaths can be drastically reduced. […] If delivery strategy bottlenecks can be overcome and the international community can collectively deliver on the key strategies outlined in these scenarios, we will be one step closer to achieving success for the United Nations’ Millennium Development Goal 4 (MDG4) by 2015. […] The complete package includes improving access to safe water, community-wide promotion of sanitation, routine rotavirus and measles immunization, vitamin A supplementation and promotion of breastfeeding, and treatment with ORS and zinc. […] The Lives Saved Tool (LiST) is designed to enable international agencies and country planners to estimate the effect of increasing coverage of selected intervention combinations, such as the UNICEF/WHO recommended interventions for diarrhea, on mortality.

• #68 Prevention and Self-Treatment of Traveler’s Diarrhea

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1539099/

  Avoidance of high-risk foods and drink is an oft-cited means of reducing the risk of traveler’s diarrhea, although there is little direct evidence that such behavior modification actually reduces disease incidence. […] Several nonantibiotic agents have been studied for the prevention of traveler’s diarrhea. […] Antibiotic prophylaxis should be given only for short courses and only under special circumstances. […] When used as prophylaxis, antibiotics should be taken daily as a single dose while in an area of risk and continued for 1 to 2 days after leaving. […] Given the existence of a relatively unabsorbed antibiotic with few side effects, the option of offering universal prophylaxis to all travelers has been raised. […] In most cases, travelers to developing countries should bring loperamide and an antibiotic to use for empirical self-treatment should they develop diarrhea.

• #69

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5731448/

  When antibiotic prophylaxis is indicated, rifaximin is recommended (Strong recommendation, moderate level of evidence). […] Fluoroquinolones are not recommended for prophylaxis of travelers diarrhea (Strong recommendation, low/very low level of evidence). […] Antibiotic treatment is not recommended in patients with mild travelers diarrhea (Strong recommendation, moderate level of evidence). […] Loperamide or BSS may be considered in the treatment of mild travelers diarrhea (Strong recommendation, moderate level of evidence). […] Antibiotics may be used to treat moderate travelers diarrhea (Weak recommendation, moderate level of evidence). […] Fluoroquinolones may be used to treat moderate travelers diarrhea (Strong recommendation, moderate level of evidence). […] Azithromycin may be used to treat moderate travelers diarrhea (Strong recommendation, high level of evidence).

• #70 How to Stop Diarrhea Fast: What to Do and What to Avoid

  https://www.healthline.com/health/how-to-get-rid-of-diarrhea-fast

  Diarrhea may go away on its own without treatment, but some OTC medications may help relieve your symptoms faster. […] The BRAT diet may help relieve symptoms of diarrhea. […] These foods may have a binding effect in the digestive tract, which makes stools bulkier, and they typically wont irritate your digestive tract. […] Taking probiotic supplements or eating probiotic foods might help restore this balance by providing high levels of good bacteria. […] Some hygiene habits like regularly washing your hands and fully cooking food may help you prevent a stomach bug. […] The rotavirus vaccine may prevent severe illness from bacteria in young children. […] Remedies like OTC medications, reducing your fiber intake, and avoiding foods that irritate your digestive system may help quickly relieve your symptoms of acute diarrhea.

• #71 Traveler’s diarrhea diet – UF Health

  https://ufhealth.org/conditions-and-treatments/travelers-diarrhea-diet

  Taking 2 tablets of Pepto-Bismol 4 times a day before you travel and while you are traveling can help prevent diarrhea. […] Most people do not need to take antibiotics every day to prevent diarrhea while traveling. […] If you have diarrhea, follow these tips to help you feel better: […] Drink 8 to 10 glasses of clear fluids every day. Water or an oral rehydration solution is best. […] Get medical help right away if you or your child has symptoms of severe dehydration, or if you have a fever or bloody stools.

• #72 Prevention and Self-Treatment of Traveler’s Diarrhea

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1539099/

  If possible, medical advice should be sought if symptoms do not diminish after initial treatment, especially in cases of persistently high fever with chills, blood and mucus in the stool, and frequent vomiting that prevents adequate fluid replacement. […] Given the large health and economic costs related to traveler’s diarrhea, more effective prevention strategies are clearly warranted.

• #73 Traveler’s diarrhea diet Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/nutrition/traveler-s-diarrhea-diet

  Taking 2 tablets of Pepto-Bismol 4 times a day before you travel and while you are traveling can help prevent diarrhea. […] Most people do not need to take antibiotics every day to prevent diarrhea while traveling. […] Get medical help right away if you or your child has symptoms of severe dehydration, or if you have a fever or bloody stools.

• #74 Travellers’ diarrhea – Canada.ca

  https://www.canada.ca/en/public-health/services/diseases/diarrhea.html

  Travellers are at higher risk when going to destinations with poor standards of hygiene and sanitation and/or eating at places with poor food handling practices. […] Consult a health care provider or visit a travel health clinic preferably six weeks before you travel. […] Practise safe food and water precautions. […] Wash your hands frequently. […] Carry oral rehydration solutions. […] Discuss prevention and treatment options of travellers’ diarrhea with your healthcare provider before you travel. […] Seek medical attention if you have bloody diarrhea, high fever, persistent vomiting, severe abdominal pain, profuse sweating, or signs of dehydration.

• #75 Traveller’s diarrhea | HealthLink BC

  https://www.healthlinkbc.ca/healthlinkbc-files/travellers-diarrhea

  If diarrhea is severe or does not improve after 24 hours, start drinking beverages that will replace the electrolytes or body salts being lost. […] Pre-packaged oral rehydration solutions are available in most countries and can be used to prevent or treat dehydration in children under 12. […] A number of medications may be recommended for treatment of traveller’s diarrhea.

• #76

  https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease

  Diarrhoeal disease is both preventable and treatable. […] A significant proportion of diarrhoeal disease can be prevented through safe drinking-water and adequate sanitation and hygiene. […] Interventions to prevent diarrhoea, including safe drinking-water, use of improved sanitation and hand washing with soap, can reduce disease risk. […] Key measures to prevent diarrhoea include: access to safe drinking-water, use of improved sanitation, hand washing with soap, exclusive breastfeeding for the first 6 months of life, good personal and food hygiene, health education about how infections spread, rotavirus vaccination. […] WHO works with Member States and other partners to promote national policies and investments that support case management of diarrhoea and its complications as well as increasing access to safe drinking-water and sanitation in developing countries. […] conduct research to develop and test new diarrhoea prevention and control strategies in this area.

• #77 Diarrhea Epidemic: Treatment And Prevention

  https://www.fasttrackurgentcare.com/addressing-the-diarrhea-epidemic-causes-treatment-and-prevention/

  When suffering from a case of diarrhea, some foods can help soothe your digestive system including bland foods like rice, bananas, and toast, often called the BRAT diet. […] Proper hand hygiene is a fundamental preventive measure against diarrhea. […] Safe food handling and preparation are essential for preventing diarrhea. […] Access to clean and safe drinking water is key to preventing diarrhea. […] Proper waste disposal is another critical aspect of sanitation that can help prevent diarrhea. […] Raising awareness about the causes, treatment, and prevention strategies for diarrhea can empower individuals and communities to take proactive steps to prevent this disease from spreading. […] Preventive measures include maintaining good hygiene practices like regular and thorough hand washing, consumption of clean water, and eating food that has been cooked properly. […] Non-medical interventions play a crucial role in both treating and preventing diarrhea. […] Practicing good personal hygiene, ensuring clean water, keeping proper sanitation, and spreading adequate education are vital in preventing diarrhea.

• #78 Diarrhea: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/4108-diarrhea

  You cant always prevent diarrhea, but you can reduce your risk of getting it because of infections or food contamination. […] Practice good hygiene: Wash your hands with soap and water after using the bathroom or preparing and eating food. Another option is to use hand sanitizer. […] Get vaccinated: The rotavirus vaccine prevents rotavirus, a common cause of diarrhea. The vaccine for COVID-19 can reduce your risk of getting COVID and experiencing COVID symptoms, including diarrhea. […] Store food properly: Store food at the correct temperatures, and cook all foods until they reach the recommended temperatures. Dont take chances by consuming foods or drinks past their expiration dates. […] Watch what you drink when you travel: Dont drink untreated water when you travel. Avoid tap water, ice cubes or brushing your teeth with tap water. Steer clear of unpasteurized milk or juice products. Pasteurization is a process that kills germs in certain drinks. When in doubt, drink bottled water or something thats been boiled first (coffee or tea). […] Watch what you eat when you travel: Avoid raw or undercooked meats (and shellfish), as well as raw fruits and vegetables. Fruits and veggies are usually healthy options, but the skin may contain contaminants that can make you sick.

• #79 Diarrhea – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/diarrhea/symptoms-causes/syc-20352241

  Diarrhea can cause dehydration, which can be life-threatening if not treated. Dehydration is particularly dangerous in children, older adults and those with weakened immune systems. […] Wash your hands to prevent the spread of infectious diarrhea. To ensure adequate hand-washing: Wash frequently. Wash your hands before and after preparing food. And wash your hands after handling uncooked meat, using the toilet, changing diapers, sneezing, coughing or blowing your nose. […] You can help protect your infant from rotavirus, the most common cause of viral diarrhea in children, with one of two approved vaccines. Ask your baby’s doctor about having your baby vaccinated. […] Diarrhea commonly affects people who travel to countries with poor sanitation and contaminated food. To reduce your risk: Watch what you eat. Eat hot, well-cooked foods. Don’t eat raw fruits and vegetables unless you can peel them yourself. Don’t eat raw or undercooked meats and dairy foods.

• #80 Travelers’ Diarrhea | Yellow Book | CDC

  https://wwwnc.cdc.gov/travel/yellowbook/2024/preparing/travelers-diarrhea

  Healthcare professionals should advise on food safety and options for medications to prevent and treat travelers diarrhea. […] Traveler adherence to recommended approaches can, however, help reducealthough never fully eliminatethe risk for illness. These recommendations include making careful food and beverage choices, using agents other than antimicrobial medications for prophylaxis, and carefully washing hands with soap whenever available. […] Where provided, effective food-handling courses have been shown to decrease the risk for TD. […] The primary agent studied for prevention of TD, other than antibiotics, is bismuth subsalicylate (BSS). Studies from Mexico have shown that this agent reduces the incidence of TD by approximately 50%. […] Probiotics (e.g., Lactobacillus GG, Saccharomyces boulardii) have been studied in small numbers of people as TD prevention, but results are inconclusive, partly because standardized preparations of these bacteria are not reliably available.

• #81 Travelers’ Diarrhea | Yellow Book | CDC

  https://www.cdc.gov/yellow-book/hcp/preparing-international-travelers/travelers-diarrhea.html

  Healthcare professionals should advise on food safety and options for medications to prevent and treat travelers diarrhea. […] Traveler adherence to recommended approaches can, however, help reducealthough never fully eliminatethe risk for illness. These recommendations include making careful food and beverage choices, using agents other than antimicrobial medications for prophylaxis, and carefully washing hands with soap whenever available. […] Where provided, effective food-handling courses have been shown to decrease the risk for TD. […] The primary agent studied for prevention of TD, other than antibiotics, is bismuth subsalicylate (BSS). Studies from Mexico have shown that this agent reduces the incidence of TD by approximately 50%. […] Probiotics (e.g., Lactobacillus GG, Saccharomyces boulardii) have been studied in small numbers of people as TD prevention, but results are inconclusive, partly because standardized preparations of these bacteria are not reliably available.

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