Article: Traveler's diarrhea.[Show abstract] [Hide abstract]
ABSTRACT: Travelers' diarrhea is common. Between 8% and 50% of travelers develop diarrhea; incidence depends on the country visited. The attack rate is highest for travelers from a developed country who visit a developing country. Children are at particular risk. Travelers' diarrhea is usually acquired through ingestion of fecally contaminated food and water. Most cases are due to a bacterial pathogen, commonly, Escherichia coli, and occur within the first few days after arrival in a foreign country. More than 90% of episodes develop within the first 2 wk of initiation of travel. Dehydration is the most common complication. Water and electrolyte replenishment is important and can usually be accomplished with an oral rehydration solution. Judicious use of an antimotility agent and antimicrobial therapy reduces the duration and severity of diarrhea. Pretravel education on hygiene and on the safe selection of food items is important in minimizing episodes. Dukoraltrade mark (Aventis Pharma Ltd., Auckland, New Zealand) vaccine should be considered for travelers who are 2 y of age or older and who will be visiting an area associated with risk of infection due to enterotoxigenic E coli or Vibrio cholerae. Typhoid vaccine is recommended for travelers who will be visiting areas with poor sanitation and hygiene.Advances in Therapy 07/2006; 23(4):519-27. DOI:10.1007/BF02850040 · 2.27 Impact Factor
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ABSTRACT: A probiotic is a "live microbial food ingredients that, when ingested in sufficient quantities, exerts health benefits on the consumer". Probiotics exert their benefits through several mechanisms; they prevent colonization, cellular adhesion and invasion by pathogenic organisms, they have direct antimicrobial activity and they modulate the host immune response. The strongest evidence for the clinical effectiveness of probiotics has been in their use for the prevention of symptoms of lactose intolerance, treatment of acute diarrhea, attenuation of antibiotic-associated gastrointestinal side effects and the prevention and treatment of allergy manifestations. More research needs to be carried out to clarify conflicting findings on the use of probiotics for prevention of travelers' diarrhea, infections in children in daycare and dental caries, and elimination of nasal colonization with potentially pathogenic bacteria. Promising ongoing research is being conducted on the use of probiotics for the treatment of Clostridium difficile colitis, treatment of Helicobacter pylori infection, treatment of inflammatory bowel disease and prevention of relapse, treatment of irritable bowel syndrome, treatment of intestinal inflammation in cystic fibrosis patients, and prevention of necrotizing enterocolitis in premature infants. Finally, areas of future research include the use of probiotics for the treatment of rheumatoid arthritis, prevention of cancer and the treatment of graft-versus-host disease in bone marrow transplant recipients.Expert Review of Anti-infective Therapy 05/2006; 4(2):261-75. DOI:10.1586/14787126.96.36.1991 · 3.46 Impact Factor
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ABSTRACT: Diarrhea is the most common illness associated with international tourism. We evaluated the efficacy of a probiotic preparation of nonviable Lactobacillus acidophilus (hereafter referred to as LA) for the prevention of traveler's diarrhea. We conducted a randomized, double-blind, controlled trial. Travelers were randomized to receive either LA or placebo twice daily from 1 day before their departure to 3 days after their return. On each day of the trip and the week following the return, travelers had to record the number and consistency of stools and their adherence to the treatment. Diarrhea was defined as > or =3 unformed stools in a 24-h period. From January 2001 to September 2004, a total of 174 subjects were randomized to each treatment group. Half of the travelers went to West Africa, and organized tours or backpacking were the most common modes of traveling. The incidence of diarrhea did not differ between the 2 groups; it was 61.4 cases per 100 person-months in the LA group (95% confidence interval [CI], 44.1-85.5) and 43.4 cases per 100 person-months in the placebo group (95% CI, 30.0-62.9) (P=.14). Adjustment for travel duration and other variables did not reveal any difference between the 2 groups (adjusted hazard ratios comparing the LA and placebo groups were 1.43 [95% CI, 0.87-2.36] in an intent-to-treat analysis and 1.38 [95% CI, 0.79-2.39] in an efficacy analysis). There was no beneficial effect of treatment with LA for the prevention of travelers' diarrhea. More studies are required to assess the efficacy of other specific probiotics (e.g., a Lactobacillus rhamnosus GG preparation) for preventing traveler's diarrhea.Clinical Infectious Diseases 11/2006; 43(9):1170-5. DOI:10.1086/508178 · 8.89 Impact Factor
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