Preparing patients to travel abroad safely. Part 4: Reducing risk of accidents, diarrhea, and sexually transmitted diseases.
OBJECTIVE
To present evidence-based recommendations on traveling abroad safely so family physicians can advise travelers on how to reduce risk of accidents, diarrhea, and sexually transmitted diseases (STDs) and how to treat diarrhea themselves if medical care is unavailable.


METHODS
A MEDLINE search from 1990 to November 1998 found 163 articles on travel and accidents, 504 on travel and diarrhea, and 42 on travel and STDs. Titles and abstracts were reviewed, and randomized controlled trials (RCTs) and systematic reviews were sought. The Cochrane Collaboration database of systematic reviews and meta-analyses was searched for studies relevant to family physicians.


RESULTS
For preventing diarrhea, RCTs demonstrate that bismuth subsalicylate, doxycycline, ciprofloxacin, and trimethoprim-sulfamethoxazole are useful prophylactics. Once travelers have diarrhea, RCTs show that loperamide and zaldaride reduce symptoms and duration; quinolones, ciprofloxacin, norfloxacin, and oral aztreonam reduce abdominal symptoms and time to last liquid stool by several days; azithromycin is effective in treatment of ciprofloxacin-resistant Campylobacter, and trimethoprim-sulfamethoxazole is effective in treating cyclospora. There are no RCTs of preventing accidents and STDs abroad. Health Canada has issued a statement summarizing the risks of acquiring STDs abroad.


CONCLUSIONS
Family physicians can advise their patients on how to reduce risk of travelers' diarrhea and how to treat it themselves on holiday. There is expert advice on how to reduce risk of STDs.
Thomas
R E
RE
Memorial University of Newfoundland, St John's. rogert@morgan.ucs.mun.ca
D000056:Accident Prevention; D019072:Antibiotic Prophylaxis; D003967:Diarrhea / Q000517:prevention & control*; D005194:Family Practice; D006801:Humans; D012749:Sexually Transmitted Diseases / Q000517:prevention & control*; D014195:Travel