Travelers’ diarrhea: Clinical practice guidelines for pharmacists

Travelers’ diarrhea (TD) is the most common travel-related illness, affecting up to 70% of travelers to certain destinations.1 Its etiology is predominantly bacterial, representing approximately 80% to 90% of illnesses,1 including diarrheagenic Escherichia coli, Salmonella, Shigella and Campylobacter species, but it can also be caused by parasites, such as Giardia and Cryptosporidium, and viruses, such as norovirus.1,2 Opportunity costs, changes to trip itineraries and seeking medical care abroad are just some of the consequences that can result from a bout of TD. Emerging data have affected the recommendations for the prevention and treatment of TD, resulting in the publication of a set of guidelines for the condition in a 2017 supplement to the Journal of Travel Medicine.3 As highly accessible experts in pharmacotherapy, pharmacists are well positioned to address travel-related concerns, particularly regarding TD, at both the prescription counter and over-the-counter (OTC) aisle. Pharmacists can draw from the guidelines to ensure patients are counselled on safe and appropriate antibiotic therapy during international travel and can direct patients to important nonprescription products supported by the guidelines and provide advice on their safe and effective use. This article summarizes the key recommendations from the 2017 guidelines of interest to practising community pharmacists. Readers requiring additional information are encouraged to consult the full guideline publication.