A 55-year-old businessman comes to the physician seeking medical advice before a trip to Southeast Asia. During his last trip to Jamaica 6 months ago, he developed diarrhea and had to miss several important meetings. His past medical history is significant for hyperlipidemia, for which he takes rosuvastatin. He has no other medical problems and is otherwise healthy. He requests a medication in case he develops diarrhea during this trip.
Which of the following would be the most appropriate treatment?

Question

A 55-year-old businessman comes to the physician seeking medical advice before a trip to Southeast Asia.  During his last trip to Jamaica 6 months ago, he developed diarrhea and had to miss several important meetings.  His past medical history is significant for hyperlipidemia, for which he takes rosuvastatin.  He has no other medical problems and is otherwise healthy.  He requests a medication in case he develops diarrhea during this trip.
Which of the following would be the most appropriate treatment?

Quizplus · Accepted Answer

11ec193a_9855_ccf9_853d_b5334f43dfe5_MD0002_00 Travelers' diarrhea affects nearly 40-60% of travelers to endemic locations. Most identifiable causes are due to enterotoxigenic (ETEC) or enteroaggregative (EAEC) strains of Escherichia coli. Patients typically develop diarrhea 4-14 days after arrival in the endemic area and usually have benign and self-limited symptoms lasting 1-5 days. Some may develop low-grade fever, malaise, anorexia, abdominal cramps, nausea, and vomiting. However, there is usually no blood or pus in the stool. Empiric treatment can be initiated without diagnostic confirmation. Treatment includes fluid replacement for volume depletion, antibiotics for moderate to severe diarrhea, and possibly antimotility agents in combination with antibiotics. However, antimotility agents do not treat the cause of the diarrhea and should not be used alone or in cases of bloody diarrhea (Choice C). They should also be stopped in patients with persistent abdominal pain or worsening symptoms. Mild diarrhea usually does not require antibiotics and resolves with fluid replacement alone. Fluoroquinolones are preferred for treatment of travelers' diarrhea in adults. However, azithromycin is recommended for children, patients allergic to fluoroquinolones, and those travelling to Southeast Asia, where there is quinolone resistance. Patients can be safely given a prescription for the recommended antibiotic and told to self-medicate at onset of moderate or severe diarrhea (> 4 times/day). Other preventative measures include drinking boiled or filtered water (including ice) and avoiding food left outside for prolonged periods. (Choices A, D, and E) Metronidazole, trimethoprim-sulfamethoxazole, and ampicillin are not 1^st-line recommendations for the treatment of travelers' diarrhea due to widespread antibiotic resistance. ^st Educational objective: Fluoroquinolones, azithromycin, and rifaximin are appropriate treatment choices for travelers' diarrhea. Patients can be given a prescription prior to travel to the endemic region and told to self-medicate at onset of moderate to severe diarrhea. Antimotility agents may be used in conjunction with antibiotics, but not in severe diarrhea. __________ References: Azithromycin and loperamide are comparable to levofloxacin and loperamide for traveler's diarrhea in United States military personnel in Turkey. (http://www.ncbi.nlm.nih.gov/pubmed/18688944) Effect of adjunctive loperamide with antibiotics on treatment outcomes in traveler's diarrhea: a systematic review and meta-analysis. (http://www.ncbi.nlm.nih.gov/pubmed/18781873)

A 55-Year-Old Businessman Comes to the Physician Seeking Medical Advice