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Traveler's diarrhea

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 10 Apr 2025
Last updated: 03 Sep 2024

Summary

Definition

History and exam

Key diagnostic factors

  • diarrhea (with or without tenesmus), cramping, nausea, and vomiting
  • dysentery (blood and fever)
  • persistent diarrhea >14 days
Full details

Other diagnostic factors

  • diarrhea without illness
Full details

Risk factors

  • travel to a high-risk destination
  • age <30 years
  • proton-pump inhibitor use
  • travelers with prior residence in higher-risk destination visiting friends and relatives
  • travel during hot and wet seasons
  • deployed military populations
  • lack of caution in food and water selection
Full details

Diagnostic tests

1st tests to order

  • stool culture and sensitivity
  • multipathogen molecular diagnostic (polymerase chain reaction)
  • protozoal stool antigens
Full details

Tests to consider

  • stool ova and parasite exam
  • Clostridioides difficile stool toxin
  • colonoscopy, endoscopy, and biopsy
  • hematology, blood chemistries, serology
Full details

Treatment algorithm

INITIAL

pretravel prophylaxis

pre-travel prophylaxis

ACUTE

nonpregnant adults: mild diarrhea

nonpregnant adults: moderate diarrhea

nonpregnant adults: severe diarrhea

pregnant

children

Contributors

Authors

Daniel T. Leung, MD, MSc

Associate Professor

Division of Infectious Diseases

University of Utah School of Medicine

Salt Lake City

UT

Disclosures

DTL receives authorship royalties from UpToDate, Inc, for a chapter on travel medicine. DTL is an author of upcoming chapters on traveler's diarrhea for the US CDC Yellow Book. DTL is the president-elect of the American Committee on Clinical Tropical Medicine and Travelers' Health - Clinical Group within the American Society of Tropical Medicine and Hygiene. DTL is an author of some of the references cited in this topic.

Jakrapun Pupaibool, MD, MS

Associate Professor

Division of Infectious Diseases

University of Utah School of Medicine

Salt Lake City

UT

Disclosures

JP declares that he has no competing interests.

Acknowledgements

Dr Daniel T. Leung and Dr Jakrapun Pupaibool would like to gratefully acknowledge Dr Mark Riddle and Professor Gregory Juckett, the previous contributor to this topic.

Disclosures

MR has given talks on the management of traveler's diarrhea for the International Society of Travel Medicine (ISTM), the CDC Foundation, the American College of Gastroenterology (ACG), and the American College of Preventive Medicine. MR has led the development of guidelines for traveler's diarrhea for the ISTM, the ACG, and the Department of Defense. This work has been unpaid but support for travel has been accepted. MR is employed with Pfizer Inc., and is working on their Lyme disease vaccine program. While this is not in conflict with traveler’s diarrhea, Pfizer also makes azithromycin, which is an antibiotic recommended for the treatment of traveler’s diarrhea. MR does not work in the area of Pfizer that develops, markets, or distributes azithromycin. MR is an author of several references cited in this topic. GJ declares that he has no competing interests.

Peer reviewers

Andrea Summer, MD

Assistant Professor of Pediatrics

Medical University of South Carolina

Charleston

SC

Disclosures

AS declares that she has no competing interests.

Phil Fischer, MD

Professor of Pediatrics

Department of Pediatric and Adolescent Medicine

Mayo Clinic

Rochester

MN

Disclosures

PF is an author of a reference cited in this topic.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Riddle MS, Connor BA, Beeching NJ, et al. Guidelines for the prevention and treatment of travelers' diarrhea: a graded expert panel report. J Travel Med. 2017 Apr 1;24(suppl 1):S57-74.Full text  Abstract

Centers for Disease Control and Prevention. CDC Yellow Book 2024: health information for international travel.​ Section 2: preparing international travelers - travelers’ diarrhea. May 2023 [internet publication].Full text

De Bruyn G, Hahn S, Borwick A. Antibiotic treatment for travellers' diarrhoea. Cochrane Database Syst Rev. 2000;(3):CD002242.Full text  Abstract

Johnson PC, Ericsson CD, DuPont HL, et al. Comparison of loperamide with bismuth subsalicylate for the treatment of acute travelers' diarrhea. JAMA. 1986 Feb 14;255(6):757-60. Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

  • Differentials

    • Food poisoning
    • Irritable bowel syndrome
    • Secondary disaccharidase (or other dietary) deficiency
    More Differentials

  • Guidelines

    • CDC Yellow Book 2024: travelers' diarrhea
    • 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea​
    More Guidelines

  • Patient information

    Diarrhea in adults

    More Patient information
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