Travellers’ diarrhea is the most predictable travel related illness affecting up to 70% of travellers to developing countries. The vast majority of cases clear on their own in a few days without treatment. Antibiotic prophylaxis for travellers’ diarrhea is not recommended as these treatments disrupt the normal gut flora and allow resistant bacteria such as extended-spectrum beta lactamase (ESBL) producing bacterial to flourish. Those taking antibiotics are more likely to become colonized with ESBL producing bacteria. These individuals can shed the bacteria upon return home for several months and close contacts and family members may become colonized with the organism. As a safer alterative, travellers should consider prophylaxis with bismuth salicylate given the good evidence for its use. Clinicians may consider prescribing a three-day supply of antibiotics to carry with patients with clear instructions to only take them for severe diarrhea, given the benefit of reduced symptom duration.
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