What are the guideline sources, guidelines and references for Traveler_s diarrhea ?
Guideline sources The following summarized guidelines for the evaluation and management of traveler's diarrhea are prepared by our editorial team based on guidelines from the International Society of Travel Medicine (ISTM 2017) and the Infectious Diseases Society of America (IDSA 2017). 1 2 Guidelines 1. Classification and risk stratification Severity grading: Recognize the definitions of severity of travelers' diarrhea: Situation Guidance Diarrhea that is tolerable, is not distressing, and does not interfere with planned activities Mild (acute) Diarrhea that is distressing or interferes with planned activities Moderate (acute) Diarrhea that is incapacitating or completely prevents planned activities Severe (acute) https://web.pathway.md/diseases/recg4KTn0QFeMKwVW 1/3 6/24/23, 4:08 PM Traveler's diarrhea Pathway All dysentery (passage of grossly bloody stools) is considered severe Diarrhea lasting 2 weeks. Persistent 2. Diagnostic investigations Microbiologic testing: As per IDSA 2017 guidelines, do not obtain diagnostic testing in most patients with uncomplicated travelers' diarrhea, unless treatment is indicated. D As per ISTM 2017 guidelines, obtain microbiologic testing in returning travelers with severe or persistent symptoms or if empiric therapy has failed. B Molecular testing: prefer obtaining molecular testing, aimed at a broad range of clinically relevant pathogens, when rapid results are clinically important or non-molecular tests have failed to establish a diagnosis. Evaluation for parasites: evaluate for intestinal parasitic infections in travelers with diarrhea lasting 14 days. B Evaluation for other causes: Obtain testing for C. difficile infection in travelers treated with antimicrobial agents within the preceding 8-12 weeks. B Consider evaluating for gastrointestinal tract diseases including IBD and post-infectious IBS in patients with travelers' diarrhea. B 3. Medical management Antibiotics (indications): do not initiate antibiotic treatment in patients with mild travelers' diarrhea. D Show 2 more Antibiotics (choice of agent): Consider administering any of the following antibiotics for the treatment of patients with moderate travelers' diarrhea: fluoroquinolones B azithromycin B rifaximin. C Show 3 more Loperamide: consider administering loperamide for the treatment of patients with mild travelers' diarrhea. B Show 2 more https://web.pathway.md/diseases/recg4KTn0QFeMKwVW 2/3 6/24/23, 4:08 PM Traveler's diarrhea Pathway Bismuth subsalicylate: consider administering bismuth subsalicylate for the treatment of patients with mild travelers' diarrhea. B Probiotics: insufficient evidence to support the use of commercially available prebiotics or probiotics for the prevention or treatment of travelers' diarrhea. I 4. Patient education Pretravel counseling: provide pretravel counseling including information about the risk of acquisition of multidrug-resistant bacteria, balanced against the benefits of antibiotic use. 5. Preventative measures Chemoprophylaxis (indications): Do not administer routine antimicrobial prophylaxis in travelers. D Consider administering antimicrobial prophylaxis in travelers at high risk of health-related complications of travelers' diarrhea. B Chemoprophylaxis (choice of agent): administer rifaximin if antibiotic prophylaxis is indicated. B Show 2 more References 1. Riddle MS, Connor BA, Beeching NJ et al. Guidelines for the prevention and treatment of travelers' diarrhea: a graded expert panel report. J Travel Med. 2017 Apr 1;24(suppl_1 S57 S74. Open 2. Shane AL, Mody RK, Crump JA et al. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis. 2017 Nov 29;65 12):e45-e80. Open https://web.pathway.md/diseases/recg4KTn0QFeMKwVW 3/3