As international travel becomes more economical and commonplace, primary care providers are increasingly called on to help prevent related health problems. Most of these problems can be avoided by taking appropriate measures.
In previous articles (CONSULTANT, August 2001, page 1289, and September 1, 2001, page 1431), I focused on travel-specific immunizations and malaria prophylaxis, respectively. Here I discuss protection against traveler's diarrhea, motion sickness, jet lag, altitude sickness, heat- and sun-related conditions, accidents, and sexually transmitted diseases (STDs). I also address the specific hazards of travel for patients with chronic health conditions, such as diabetes and cardiovascular disease.
The most common travel-related illness is diarrhea. The risk depends on the destination. At highest risk are persons who travel to Africa, Asia, and Latin America (20% to 50% risk). The risk is more moderate for those going to the Mediterranean or Caribbean regions (8% to 20% risk). Even those who visit the United States, Canada, northern Europe, and Australasia still face limited risk (up to 8%).1
Although diarrhea is commonly viewed as a minor problem, it can have a significant effect on business or pleasure trips. At least 20% of travelers who contract diarrhea spend part of their trip bedridden, and 40% change their itinerary because of diarrhea.2 Causes of traveler's diarrhea include enterotoxigenic Escherichia coli (which usually produces a self-limited illness that lasts only a few days), Campylobacter, Shigella, Salmonella, viruses, and parasites.
Prevention. Educate patients about basic preventive measures (Table 1). Simple hygiene and safety measures-such as frequent hand washing with soap and water, use of bottled water for drinking and brushing teeth, and eating well-cooked, hot foods-appear to greatly reduce the risk of diarrhea. Also, advise patients to avoid consumption of foods purchased from street vendors, uncooked foods (other than fruits or vegetables that they have peeled themselves), nonbottled beverages, and unpasteurized dairy products.
Prophylaxis for traveler's diarrhea is no longer routinely recommended by most experts because of expense, possible adverse effects, and the risk of increased antibiotic resistance. Reserve prophylaxis for patients who may be forced to eat in areas where the safety of food and beverages is questionable, for those with reduced immunity, and for those in whom the potential consequences of illness could be profound. In such cases, preventive antibiotic therapy for adults consists of one of the following regimens, which should be followed daily while traveling, for a maximum of 3 weeks:
- Ciprofloxacin, 500 mg/d.
- Levofloxacin, 500 mg/d.
- Ofloxacin, 300 mg/d.
- Norfloxacin, 400 mg/d.
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