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
this is a treatment option for TD when dehydration is a concern (e.g. infants, young children, special populations, elderly). e.g. gastrolyte and pedialyte
oral rehydration solution
this can be used for treatment of mild TD. reduces the number of stools passed by 50%. large doses are often required. can also be effective in treating nausea.
bismuth subsalicylate
this can be used for treatment of mild, moderate or severe TD. should take 4mg initially then 2mg after each bowel movement (max 16mg/day). can be used in conjunction with antibiotics if fever or bloody diarrhea is present. do not use in children under 2
loperamide
this can be used for treatment of TD and is useful in patients with fever and/or bloody diarrhea.
fluoroquinolones
what is the prophylactic dose of ciprofloxacin?
500 mg PO daily
what is the 3 day Tx dose of ciprofloxacin?
500 mg PO BID x 3/7
what is the once day Tx dose of ciprofloxacin?
500-1000mg x 1 dose
this can be used in treatment of TD when the bacteria is fluoroquinolone resistant. safe in children and pregnancy.
adults: 1000mg po dose
children: 500mg po daily x 3 days
azithromycin
this is caused by four protozoan species of the genus plasmodium. transmitted by bite of infected female anopheline mosquitos and multiplies within red blood cells
malaria
what are some symptoms of malaria?
- chills
- fever
- myalgia
- headache
- malaise
- fatigue
- N/V
- if severe: can cause anemia, jaundice, kidney failure, convulsions
true/false: malaria can be curable if diagnosed and treated quickly
true
what is the incubation period of malaria in most cases?
7-30 days
* malaria can develop 7 days after initial exposure or several months after leaving the area
what are some risks of acquiring malaria?
- travel destination
- degree or rural travel
- altitude?
- time of travel (hot season > cold)
- duration of travel (longer = higher risk)
- type of accommodations (e.g. nets)
- efficacy and compliance with prophylactic measures
what are some preventative measures for malaria?
- avoiding mosquito bites (minimizing exposure of skin with clothing, use EPA registered insect repellants)
- stay in well screened, air-conditioned housing and sleep under nets
- permethrin 0.5% to treat clothing and gear do not use on skin
true/false: all travellers to endemic areas require prophylaxis
true
what is the first line option for prophylaxis of malaria?
chloroquine is the first line, hydroxychloroquine is a suitable alternative as long as there is no chloroquine resistance
what options may be used for the prophylaxis of malaria if there is chloroquine resistance?
doxycycline, atovaquone/proguanil (MALERONE) or Mefloquine (do not use mefloquine if possible - very bad hallucinations) are options
which malaria chemoprophylaxis drugs are dosed once daily?
- atovaquone/proguanil (MALERONE)
- doxycycline
which malaria chemoprophylaxis drugs are dosed once weekly?
- chloroquine
- hydroxychloroquine
- mefloquine
true/false: all travellers who develop fever within one year (especially within 3 months) of return from malaria-endemic area must be considered to have malaria and seek medical attention
true
true/false: malaria is not life-threatening in pregnancy
false
how can malaria be prevented in pregnancy
- defer travel if possible
- can use DEET
what malaria chemoprophylaxis options are safe in pregnancy?
- chloroquine
- mefloquine
- others are contraindicated *
true/false: malaria is not life-threatening in children <5
false
how can malaria be prevented in children
- defer travel if possible
- use DEEt
what malaria prophylaxis can be used for children?
- chloroquine is recommended
- atovaquone/proquanil (MALERONE) can be used if > 5 kg
- doxy is contraindicated*
true/false: pharmacists can prescribe for hepatitis A and hepatitis B vaccines
true
this immunization is recommended for all non-immune travellers that is going to this type of endemic country - often developing countries where sanitation and hygiene may be poor. transmission is via the fecal-oral route (person to person contact, contamination of environment or objects through contaminated food/water)
hepatitis A
when should the hepatitis A vaccine be administered?
- one dose of single antigen administered anytime prior to departure provides protection for healthy individuals
- second dose 6-12 months after the first provides longer term prevention (up to 10 years)
e.g. Havrix
this immunization is recommended for are non-immune travellers that is going to this type of endemic area. risk is generally low. transmitted through percutaneous or mucosal contact with infectious bodily fluids (sexual contact, piercings, tattoos)
hepatitis B
when should the hepatitis B vaccine be administered?
- 3 dose series at 0, 1 and 6 months
- generally protected for life if receive full series
- immunization should start 6 months before travel
e.g. Energix-B
true/false: Twinrix is a combined hepatitis A and B vaccine. since its combined it only needs to be administered once
false - still a 3 dose series due to hepatitis B component
what are some symptoms of jet lag?
- malaise
- fatigie
- irritability
- disruption of sleep-wake cycles
- imparted cognitive performance
true/false: jet lag is worse when travelling eastward
true - easier to extend a day then shorten it
what are some tips to tell patients experiencing jet lag?
- be well rested before travel
- if travelling west: go to bed an hour or two later; if travelling east go to bed an hour or two earlier
- remain well hydrated during travel
- exposure to outdoor daylight may help reset circadian rhythm
this medication (OTC) has not been thoroughly tested to treat jet lag; some studies show 3-5mg can alleviate symptoms. take close to target bedtime at destination, do not take prior to leaving for travel
melatonin
true/false: IR melatonin preparations are less effective than SR preparations
false: SR preps are less effective than IR
