Travel medicine Flashcards
Why are antibiotics not routinely used for the prevention of TD?
Because of R.A.P.E
Resistance
Adverse effects
Predispose to infection (c.diff)
Expense
when would it be recommended to use a antibiotic for prophylaxis of TD?
- high risk of getting diarrhea
- risk of complications from diarrhea
3/ when staying healthy is critical
What are the medications that can be used for TD prevention?
- antibiotics (floroquinoles, azithromycin, and rifaximin)
- bismuth subsalisylate
- dukoral
- natural health products
what are the different types of FG used for TD?
ciprofloxacin, levofloxacin and norafloxicin
What would be the first line antibiotic used for prevention of TD? one limitation of it?
FQ - ciprofloxacin
Some areas have increased resistance to it such as EA asia, nepal and Indonesia so we have to use azithromycin
When would we use azithromycin over ciprofloxacin?
cases of resistance
how does dosing change baded on prohylais dose and treament dose?
prophylaxis dose is lower then the tretament dose
How does rifaximin work? MOA?
it works in the gut by limiting systemic absorption
- it is 70% effective for prophylaxis treament
why isn’t rifaximin indicated for prophylaxis use in Canada
the dosage form we have available is too high
What are some adverse effects of BSS use for prevention?
black stool
how long can we use BSS for prevention of TD?
less then 3 weeks
When is BSS use CI in TD prevention?
- pregenancy
- less then 18
- blood thinners
-SA allergy
How does dukoral work for TD prevention
it’s an oral vaccine with cholera and inactivated TD diarrhea
how is dukoral effective against ETEC?
the cholera vaccine has the same sub unit as ETEC
What preventive medications are not highly effective?
Azithromycin - limited evidence to prove it works well
Dukorla - should only be used in high-risk indivduals
Natural health products
Are are the treament options for TD?
-oral rehydration solutions
- BSS
-Loperamide
- antibiotics
When are Oral rehydration solutions indicated?
for infants, children, elderly and special populations
when is BSS use indicated for tx?
in mild TD
How does BSS use help in treatment of TD?
it reduces stoll passes by 50%
What’s an advantge of BSS over loperimide?
helps with Nausea
What’s the advantage of loperamide over BSS?
loperamide is faster acting and can be used in combiantion with antibiotics to help
when is loperamide recommended for tx of TD?
for mild, moderate, and severe TD
when is loperamide contraindiacted for tx of TD? and why
-fever, bloody stool
because it slows down peristalsis in gut and won’t let infectious agents out of body causing more complications
- also in children under 2 year of age
When are antibiotics indicated for tx of TD?
in severe cases with fever and bloody diarrhea
What is a big CI of rifaximin use in tx of TD?
can’t be used in for patients with dysentry (fever, bloody diarhea)
is rifaximin indicated for tx of TD in cacnda?
No
What antibiotic if any should be given to pregnant women and childre?
Azithromycin
in what time frame can malaria develop?
7 days to months after initial exposure
What are some malaria prevention agents?
DEET 30%
Picardin 20% - in off spray
permethrin 0.5%
What should clothes be treaed with to help avoid malaria?
permethrin 0.5%
Whihc prevention products CANNOT have direct contact with skin?
permethrin 0.5%
What are chemoprophylaxis options for malaria
chlorquine, hydroxychlorquine, mefloquin, doxycycline, atovaquone/proguanil
what chemoprophylaxis options for malaria cause horrible psychiatric conditions
mefloquin
If a tarveler presents with a fever around a year after travling to a malaria endmic country do we assume it may be malaria or has it been too long to conclude that?
they may have malaria
What product/s can a pregnant woman use as insect repellent?
DEET
What product/s can a pregnant woman use as chemoprophylaxis for malaria?
chloroquine
What product/s can children NOT use as chemoprophylaxis for malaria?
Doxy
What product/s can children use as chemoprophylaxis for malaria?
chloroquine
what are the three reasons for immunizations?
- routine preventavie helath
- required for travel
- recommended according to diseases acquisition
what immunization are we focusing on?
Hep A and B
whihc Hep is more common
Hep A
How many doses and what dosing schedule exist for hep A
2 doses
second dose 6-12 months after first
gives 10 years of protection
how is hep A transmitted?
the fecal-oral route
how is hep B transmitted?
percutanous or mucousal exchange (sexual conduct, pericings, tattoes)
How many doses and what dosing schedule exist for hep B
3 doses
0, 1, 6 months
protection for life
What is the combination vaccine for hep a and hep b called?
twinrix
fill in the blank: in terms of jet lag for every __ of travle 1 day is needed to acclimatize
1
going east or west is harder? Y?
going east because the day gets shorter and not longer
Is melatonin IR or SR more effective?
IR
Going west how should we adjust our sleep schulde
go to bed one to two hours later
What are some preventive measure for venous thromboembolism
excerisie
hydrate (no alcohol)
compression socks
