1. Travel Medicine MT1 Flashcards
sudden onset of abnormally loose or liquid frequent stools with functional impact; often self-limiting
travellers diarrhea
type of travellers diarrhea: it is tolerable, not distressing and does not interfere with planned activities
mild travellers diarrhea
type of travellers diarrhea: is distressing and interferes with planned activities
moderate travellers diarrhea
type of travellers diarrhea: completely prevents planned activities and consists of bloody stools
severe travellers diarrhea
travellers diarrhea is most commonly caused by ______
E. coli
how many days after arrival does travellers diarrhea usually begin to occur?
4-14 days
true/false: travellers diarrhea is normally self limiting within 3-5 days without tx
true
_______ is a potential complication of TD
dehydration
what are some risk factors when it comes to TD?
- immunocompromised
- infants (<2 y/o)
- elderly
- low stomach acid (e.g on a PPI)
- pt’s with chronic diseases
what are the goals of therapy when treating someone with TD?
- reduce risk of infection in travellers
- limit duration and severity of symptoms when travelling and post-travel
what are some ways you can prevent getting travellers diarrhea?
AVOID
- room temp. buffet foods
- ice/tap water
- undercooked foots
- street vendors
- already peeled fruit
- condiments on table
- raw veggies/cold salads
DO:
- wash hands frequently
- drink safe beverages (bottled water, pop)
- water purification by boiling
why are antibiotics not routinely recommended for prevention of travellers diarrhea
- adverse effects (e.g. diarrhea)
- resistance
- predispose to other infections (E.G. C. DIFF)
when are antibiotics recommended for prevention of travellers diarrhea?
- when staying healthy is critical (e.g. traveling to a third world country where tx is not available)
- travellers where risk for diarrhea is increased
- travellers at risk of complications of diarrhea
what is the first line for chemoprophylaxis for travellers diarrhea?
fluoroquinolones (e.g. ciprofloxacin, levofloxacin, norfloxacin)
what may be used for chemoprophylaxis of travellers diarrhea if person is traveling to a place that has fluoorquinolone resistance?
azithromycin
true or false: prophylaxis is prescribed long term
false - if used low doses should be used and for short term only (< 3 weeks)
This is an antibiotic that is suggested by CATMAT for prophylaxis and treatment of TD, but is not indicated in Canada due to dosage formulation (supplied as a 550mg tablet but Px= 600mg OD and Tx = 200mg TID x3/7)
Rifaximin (ZAXINE)
this is an OTC medication that can be used for prevention of travellers diarrhea. it decreases the attack rates of TD, and has antibacterial activity along with antisecretory and anti-inflammatory properties.
bismuth subsalicylate (PEPTO-BISMOL)
true/false: AE’s of pepto-bismol are limited with short term use (< 3 weeks)
true
what are some common side effects of pesto-bismol?
- black hairy tongue
- constipation
- black stools
what are some contraindications of pepto-bismol?
- pregnancy
- taking blood thinners
- subsalycilate allergy
- toddlers (risk of reyes syndrome)
this is an oral inactivated traveller’s diarrhea and cholera vaccine; first dose is taken 2 weeks before departure and 2nd dose is taken one week before departure. used in patients at high risk
dukoral
probiotics are natural health products that can be used for the prevention of TD. when should you start taking them before you travel?
2-3 days before departure and continue whilst traveling
this is a natural health product used to prevent TD. it is a bovine colostrum powder made from first milk of cows after giving birth to calf (in those cows immunized to ETEC). the antibodies attach to the e.coli bacteria and inhibit attachment to the intestinal wall. should start 48 hr before trip and take TID before meals whilst on trip
Travelan