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Traveler's diarrhea

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of traveler's diarrhea are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2025), the Infectious Diseases Society of America (IDSA 2017), the International Society of Travel Medicine (ISTM 2017), and the American College of Gastroenterology (ACG 2016).
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Classification and risk stratification

Severity grading: as per ISTM 2017 guidelines, recognize the definitions of severity of traveler's diarrhea:
Situation
Guidance
Mild (acute)
Diarrhea that is tolerable, is not distressing, and does not interfere with planned activities
Moderate (acute)
Diarrhea that is distressing or interferes with planned activities
Severe (acute)
Diarrhea that is incapacitating or completely prevents planned activities
All dysentery (passage of grossly bloody stools) is considered severe
Persistent
Diarrhea lasting ≥ 2 weeks
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Diagnostic investigations

Microbiological testing: as per IDSA 2017 guidelines, do not obtain diagnostic testing in most patients with uncomplicated traveler's diarrhea, unless treatment is indicated.
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  • Molecular testing

  • Evaluation for parasites

  • Evaluation for other causes

Medical management

Symptomatic therapy: as per AAFP 2025 guidelines, consider offering oral fluid intake, bismuth subsalicylates, and a 4-mg dose of loperamide for non-bloody traveler's diarrhea with mild symptoms not hindering daily activities.
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  • Antibiotic therapy (indications)

  • Antibiotic therapy (choice of agent)

  • Probiotics

Patient education

Pretravel counseling: as per ISTM 2017 guidelines, provide pretravel counseling including information about the risk of acquisition of multidrug-resistant bacteria, balanced against the benefits of antibiotic use.
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Preventative measures

Chemoprophylaxis, indications
As per ISTM 2017 guidelines:
Do not administer routine antimicrobial prophylaxis in travelers.
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Consider administering antimicrobial prophylaxis in travelers at high risk of health-related complications of traveler's diarrhea.
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  • Chemoprophylaxis (choice of agent)

  • Probiotics