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PharmD > Traveller's Diarrhea > Flashcards

Traveller's Diarrhea Flashcards

1
Q

What is the incubation period of traveller’s diarrhea?

A

2 weeks

Incidence rate of TD within the initial 2 weeks of stay determines the risk of TD

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2
Q

What are the risk categories for traveller’s diarrhea?

A

High >20%
Intermediate 8-20%
Low <8%

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3
Q

TD is usually ____-__________ even without therapy. It usually lasts <___hrs.

A

Self-limiting
<48 hrs

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4
Q

Does an episode of TD protect against future attacks?

A

No, you can get multiple in a single trip

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5
Q

What are the different severities of traveller’s diarrhea?

A

Mild= tolerable, no distress, does not interfere with plans
Moderate= distressing, interferes with plans
Severe= incapacitating, completely stops plans
Dysentery= grossly bloody stools (automatically severe)
Persistent= ≥2 weeks

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6
Q

What are the bacterial pathogens involved in TD?

A

E. coli, campylobacter, salmonella, shigella

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7
Q

What are virus pathogens?

A

Norovirus, astrovirus, rotavirus

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8
Q

What are protozoa pathogens involved in TD?

A

Giardia, cryptosporidium

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9
Q

What are symptoms that indicate more severe infection and warrant evaluation?

A

High fever, mucoid stools, persisting >2 weeks after return

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10
Q

A helpful non-pharm tip is:
____it, ____it, ____it, or forget it.

A

Boil, cook, peel

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11
Q

Are carbonated drinks safe for traveller’s diarrhea prevention?

A

Yes

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12
Q

Are alcoholic drinks safe for traveller’s diarrhea prevention?

A

No

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13
Q

What are four ways that water can be sterilized for drinking?

A

Heat, filtration, chemical, UV

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14
Q

How do you sterilize water by heat?

A

Boil for 1 min

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15
Q

How do you sterilize water by filtration?

A

Apply filter which should be followed by chemical disinfection if possible.

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16
Q

How do you sterilize water by chemical?

A

Chlorine or iodine

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17
Q

For individuals travelling to high rates of TD, what drug class should we consider reassessing the need for?

A

PPIs and H2RAs

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18
Q

What are four agents that may be used for prevention of TD?

A
  1. Bismuth Subsalicylate (Pepto)
  2. Antibiotics
  3. Vaccines
  4. Probiotics
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19
Q

How has bismuth subsalicylate been postulated to help prevent TD?

A
  1. Anti-bacterial
  2. Anti-secretory
  3. Anti-inflammatory
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20
Q

What is a common side effect of bismuth subsalicylate?

A

Black stool which can be confused with melena

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21
Q

When should we avoid bismuth subsalicylate?

A
  1. Patients taking anticoagulants or salicylates
  2. Allergic to salicylates like ASA
  3. Young children (risk of bismuth encephalopathy). Not for <2
22
Q

Are antibiotics routinely recommended for TD?

A

No. It increases the risk of adverse events, C. difficile, and antimicrobial resistance

23
Q

Who would typically get antibiotics for TD?

A
  1. High risk of TD or complications (immunocompromised, comorbid disease)
  2. Critical travel (diplomatic missions)
  3. Diarrhea every time they travel
24
Q

How long should we limit antibiotic prophylaxis for?

A

<3 weeks

25
Q

Which antibiotics are typically used for TD prophylaxis?

A

Fluoroquinolones
- ciprofloxacin
- levofloxacin
- norfloxacin

Azithromycin

Rifaximin (not available in Canada)

26
Q

Which antibiotics are not recommended for TD prevention anymore due to bacterial resistance?

A

Doxycycline and Septra

27
Q

When can we not use the fluoroquinolones for TD prevention?

A

Southeast Asia
Ex: Thailand, India, Nepal, Indonesia

Azithromycin would be the preferred alternative

28
Q

What’s the name of the vaccine for TD? How does it work?

A

Dukoral
- contains non-toxic B subunit of cholera toxin which is very similar to toxin of E.coli

29
Q

Is the cholera vaccine routinely recommended?

A

No. Considered in short-term travellers at high risk of health complications or serious inconveniences due to TD.

30
Q

There is limited evidence for use of probiotics in TD, but which two strains seem to provide benefit?

A

Lactobacillus rhamnosus GG, Saccharomyces boulardii

31
Q

If patient has mild diarrhea, what diet should they follow?

A

Banana
Rice
Apple sauce
Toast

-Hydrate (electrolytes)
-limit fatty or oily foods
-avoid natural laxatives (caffeine, alcohol, excessive fruit
-limit dietary fibre as it can worsen bloating or cramping

32
Q

What are four agents that may be used for treatment of TD?

A
  1. Oral rehydration therapy
  2. Bismuth Subsalicylate
  3. Loperamide
  4. Antibiotics
33
Q

When is ORT recommended for treatment of TD?

A

Cornerstone therapy (especially for infants, pregnant women, and frail elderly)

34
Q

If ORT is not available, what’s an emergency substitute?

A

1L of safe water+ 1/2 tsp of salt+ 6 tsp of sugar

35
Q

How does bismuth subsalicylate help treat TD?

A

Reduce duration and frequency of diarrhea

36
Q

When is antimotility agents like loperamide used in TD?

A

mild to moderate diarrhea

37
Q

When should loperamide be avoided?

A
  1. children <2
  2. bloody diarrhea
  3. fever
38
Q

When do antibiotics come into TD treatment?

A

Mild diarrhea is managed with ORT, loperamide and/or bismuth subsalicylate.

If these fail or more serious symptoms (blood, cramps, high fever) present, start antibiotics.

39
Q

Which antibiotics are effective in treating TD?

A
  • Fluoroquinolone for ETEC predominant areas like America and Africa
  • Azithromycin for Asia (especially Thailand, Indonesia, Nepal, India, and Mexico)
  • Rifaximin (not available in Canada)
  • Septra no longer recommended
40
Q

What class of antibiotic is not recommended in children?

A

fluoroquinolones

41
Q

In children, what is the age requirement for loperamide?

A

Must be older than 2, and treatment should not exceed 2 days

42
Q

In children, what is the age requirement for bismuth subsalicylate?

A

Must be older than 2 and caution in those younger than 12.

43
Q

Is chemoprophylaxis recommended in pregnancy?

A

No

44
Q

How do you treat TD in pregnancy?

A

ORT, loperamide, azithromycin

Avoid bismuth subsalicylate, fluoroquinolones, and iodine

45
Q

Should breastfeeding be continued during travel?

A

Yes, safer for baby

46
Q

How do you treat TD in breastfeeding?

A

ORT, loperamide, azithromycin

Avoid bismuth subsalicylate, fluoroquinolones, and iodine

47
Q

Is it better to use antibiotics for prophylaxis or treatment?

A

Treatment

48
Q

Mild TD usually resolves within ____ hours with loperamide, BSS, or fluids.

A

24 hours

49
Q

If symptoms persist for >___ week after returning home, investigate for other causes.

A

2 weeks

A common cause is IBS. Other considerations include parasitic infection or antibiotic associated colitis.

50
Q

If patient has fever or dysentery, seek medical attention if symptoms don’t improve within ___ hours despite therapy.

A

48 hours

51
Q

What’s the treatment algorithm for traveller’s diarrhea?

A

Mild= loperamide and/or bismuth -> refer if longer than 2 weeks
Moderate= ORT, loperamide and/or antibiotic -> refer if longer than 2 weeks
Severe= ORT + antibiotics (+/- loperamide if not dysentery) -> refer if longer than 48 hrs after starting antibiotics

PharmD (11 decks)

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