From 20 to 50% of travelers to tropical and subtropical regions, including Latin America, partly the Caribbean, South Asia and Africa, get sick with travelers' diarrhea (PD). Usually the disease tends to go away on its own, with a symptom duration of less than 1 week and is undoubtedly the most common disorder of this category of citizens. In addition to the impact, the DP causes impressive financial losses, both from travelers and from the budgets of the countries themselves, where they come from, hampering the implementation of business plans and causing loss of tourism revenue.

Food warnings. Prevention of travelers' diarrhea begins with nutritional recommendations. Travelers are particularly advised to avoid consuming tap water, products processed by it (salads, green vegetables, etc.), ice, unpasteurized milk, sauces, processed seafood. thermally and raw or non-fried meat. Eating food purchased from street vendors presents a particularly high risk of developing PD. Food and beverages, including carbonated bottles, must be stored properly; Eat fully heat-treated and freshly prepared foods, dry foods like bread and cereals.

Bismuth subsalicylate. Prevents 60 to 65% of travelers' diarrhea and can be used as a preventative. However, it is necessary to take it four times a day to get a complete preventive effect, which can lead to tinnitus and black spots on the tongue and stool.

Antibacterials. It has long been known that prescribing antibiotics reduces the rate of travelers' diarrhea. The effectiveness of prophylactic prescribing of antibiotics is probably due to the fact that the vast majority of cases of PD (approximately 80%) are caused by bacteria, most often enterotoxigenic E. coli (ETEC) ), less often by other pathogenic representatives of the family Enterobacteriaceae, Campylobacter and non-cholera vibrios. However, antibiotics have several drawbacks, including the risk of allergic reactions and photosensitivity, diarrhea associated with antibiotics, Candida vaginitis and the development of resistance to antibiotics. Therefore, they should only be used in travelers with immune deficiencies, nonspecific inflammatory bowel disease or in situations where PD threatens serious medical and social consequences.

Although the benefit / risk ratio does not justify the use of antibiotics for the prevention of PD, antimicrobial treatment after the onset of acute PD generally reduces the duration of the disease to 2-3 days, reversing the ratio in a positive direction. A 3-day antibiotic treatment was administered to those who went abroad and contracted severe diarrhea in the homes. More medication may be given if you are planning a long stay, to use it in case of repeated episodes of PD.

Quinolones and macrolides. Quinolones are the most commonly prescribed drugs due to their antibacterial spectrum, favorable safety profile and effectiveness when given short-term. The main problems encountered with the use of quinolones are associated with contraindications in children and pregnant women, as well as an increase in resistance in Campilobacter spp. in Thailand, Nepal and other regions. Macrolides, like azithromycin, are able to overlap these resistant strains and become the drugs of choice in these geographic regions. The use of cotrimoxazole, which was previously the basis of DP therapy due to its low cost and its activity against Cyclospora, seems to be an obsolete approach due to the generalized resistance, the frequency toxic allergic reactions and drug interactions with other drugs.

New antibiotics. Rifaximin, a non-absorbable rifamycin derivative currently awaiting FDA approval for use in the United States, has similar efficacy to fluoroquinolones in the management of PD and may also play a positive role in prevention. The strong activity of rifaximin against gram-positive, gram-negative, aerobic and anaerobic pathogens has been established. The drug is well tolerated and has a safety profile comparable to that of placebo. In addition, the drug is not associated with stable resistance. Rifaximin is probably safer than other drugs in children and pregnant women, and no drug interactions have been observed with its use. It is considered a new standard in the management of intestinal infections and has great prospects in the field of prevention of PD, where systemic side effects and safety considerations determine the benefit / risk ratio versus use other antibiotics.

Are probiotics useful? Probiotics, which are living microbial food additives that positively affect the macroorganism by improving the microbial balance of the digestive tract, have been tested as prophylactics for travelers with diarrhea. Small studies involving 50 American travelers to Mexico and British soldiers sent to Baileys have not demonstrated the benefits of Lactobacillus acidophilus, Lactobacillus fermentum and Lactobacillus bulgaricusfor prevention of PD.

However, Lactobacillus GG (LGG) are distinguished by their resistance to sterilization by gastric juice and bile and the ability to precipitate and colonize the intestine, and the results of two different studies on their use is promising for the use of this species as a means of prevention. travelers' diarrhea. In a study on the study of PD among Finns who visited two sites in Turkey, it was found that the effectiveness of prevention was 8% and 38.5%. In another study evaluating the use of LGG in 245 subjects traveling to various locations in Asia, Africa and Central and South America, the effectiveness of prevention of PD reached 47%. In these two studies, a unique LGG dosing schedule was used.

The new PUNDIT study, scheduled as the largest in number of subjects, aims to recruit 500 to 1000 patients in different clinics. Using a three-way format, the researchers hope to compare the daily single and double dose of LGG with the placebo.