Travelers’ Diarrhea

To the editor:

I thought the answer to the Clinical Inquiry on travelers’ diarrhea¹ was very well done. There was one other question to which I would have liked the answer, because it would have helped me put in perspective how much of a benefit it is to decrease the duration of symptoms by 1 to 2 days. That question is: What is the natural history of travelers’ diarrhea without antibiotic therapy?

Neil Korsen, MD
Maine Medical Center
Portland

Reference

• Spencer DC, Rodgers PE. J Fam Pract 2001; 6:495.

Dr Spencer Responded As Follows:

Thank you for this perceptive question. There is more variability in how long travelers’ diarrhea lasts than in how long antibiotics decrease the length of the illness. One of the early articles on travelers’ diarrhea studied 133 US students in Mexico. Twenty-nine percent developed diarrhea that lasted an average of 3.4 days.¹ A Cochrane review notes that recovery within 5 days is normal.² The Centers for Disease Control and Prevention (CDC) quotes a median duration of diarrhea as 3 to 4 days.³ Reducing such a short illness by 1 to 2 days may not seem worthwhile, but many authors comment on the difference it can make in the success of a business or vacation trip.

Donald C. Spencer, MD
University of North Carolina at Chapel Hill

References

• Gorbach SL, Kean BH, Evans DG, et al. N Engl J Med 1975; 292:933-36.
• De Bruyn G, Hahn S, Borwick A. The Cochrane database of systematic reviews. Updated May 31, 2000.
• Centers for Disease Control and Prevention. Information for health care providers: travelers’ diarrhea. Available at www.cdc.gov/travel/diarrhea.htm. Accessed June 25, 2001.