title: Management of travelers' diarrhea by local physicians in tropical and subtropical countries--a questionnaire survey.
abstract: BACKGROUND
  There is an ongoing debate as to whether patients with travelers' diarrhea (TD) should self-medicate with a travel kit in developing countries or whether they should consult local doctors. Thus, we have analyzed TD management conducted by local health professionals.
  
  
  METHODS
  Practicing physicians recommended to tourists in Goa (India), Mombasa (Kenya), and Phuket (Thailand) were invited to participate in a cross-sectional questionnaire survey. Three TD case descriptions were presented, and suggested diagnostic and therapeutic procedures were analyzed.
  
  
  RESULTS
  In each of the three locations, approximately 20 physicians (59 in total, response rate 95%) completed the questionnaires. Oral rehydration was proposed by more than 80% of the physicians for mild cases of TD and for TD with vomiting, while 73% of them would have treated febrile TD patients orally and 17% would have used intravenous (IV) fluids. Antimicrobials, primarily fluoroquinolones, would have been prescribed for 61, 73, and 95%, respectively, of these three cases. Cephalosporins, aminoglycosides (usually IV gentamicin), IV amoxicillin, and once co-trimoxazole were recommended. Many medical doctors added nitroimidazole to the antibiotic therapy. Multiple symptomatic drugs would have been prescribed. The rate of invasive procedures (infusions, injections, and diagnostic venipuncture) would have ranged from 20% to 86% in the scenarios of the different patients. Mainly practitioners who owned a clinic would have hospitalized patients with TD.
  
  
  CONCLUSIONS
  Many physicians in destination countries treat TD patients similarly to the treatments prescribed in the "Western world." A minority uses obsolete antimicrobials. Polypharmacy and the high rate of invasive procedures with a theoretical risk of nosocomial infection are of concern. Training initiatives for both local physicians and travelers might be beneficial, and the guidelines should be based on internationally accepted expert advice.
authors.affiliation: Division of Epidemiology and Prevention of Communicable Diseases, World Health Organization Collaborating Centre for Travellers' Health, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland.
authors.forename: Maria N
authors.initials: MN
authors.lastname: Wyss
authors.forename: Robert
authors.initials: R
authors.lastname: Steffen
authors.forename: Nitin Y
authors.initials: NY
authors.lastname: Dhupdale
authors.forename: Sumit
authors.initials: S
authors.lastname: Thitiphuree
authors.forename: Margot
authors.initials: M
authors.lastname: Mutsch
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000382:microbiology / Q000628:therapy*; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007194:India; D007630:Kenya; D008297:Male; D010820:Physicians / Q000523:psychology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013785:Thailand; D014195:Travel; D014329:Tropical Climate
chemical_list: D000900:Anti-Bacterial Agents