Setting standards for the prevention and management of travellers' diarrhoea in elite athletes: an audit of one team during the Youth Commonwealth Games in India.
OBJECTIVE
Devise and implement evidence-based guidelines for the prevention and management of travellers' diarrhoea (TD), and establish the incidence of TD during an elite sporting trip to India.


METHODS
Literature review and audit.


METHODS
Youth Commonwealth Games in India 2008.


METHODS
All members of the Team England Squad.


METHODS
Hygiene guidelines included only drinking bottled water, eating hot food and regular hand washing with alcohol gel. Ciprofloxacin was offered to non-athlete team members as prophylaxis but not to athletes due to its possible association with tendon disease. Following implementation of these guidelines, the incidence of travellers' diarrhoea (TD) in the whole squad was 24/122 (20%), compared with 7/14 (50%) on the reconnaissance trip (preguidelines). In those taking prophylactic ciprofloxacin, the incidence was 4/33 (12%), compared with 20/89 (23%) in those not taking ciprofloxacin. No athlete missed their event due to TD.


CONCLUSIONS
The incidence of TD was less during the event than on the reconnaissance trip. The relative contribution to this reduction in strict hygiene guidelines as compared with potentially improved catering hygiene arrangements is unknown. Prophylactic ciprofloxacin also reduced the incidence of TD but it is probably not appropriate for use in elite athletes. Rifaximin may be an alternative for this group.
Tillett
E
E
Olympic Medical Institute, London, UK.
Loosemore
M
M
D000293:Adolescent; D000890:Anti-Infective Agents / Q000627:therapeutic use; D056352:Athletes; D002939:Ciprofloxacin / Q000627:therapeutic use; D002985:Clinical Protocols; D003967:Diarrhea / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control*; D004739:England / Q000208:ethnology; D006293:Health Promotion / Q000592:standards; D006801:Humans; D006920:Hygiene / Q000592:standards; D015994:Incidence; D007194:India / Q000453:epidemiology; D008485:Medical Audit; D014195:Travel
D000890:Anti-Infective Agents; D002939:Ciprofloxacin