Abstract
Abstract Bismuth subsalicylate and antibiotics can prevent a substantial proportion of travelers' diarrhea. Bismuth subsalicylate remains an option but has to be taken four times a day. Of the antibiotics with potential benefits, the fluoroquinolones can no longer be recommended owing to the potential for tendonitis. Azithromycin is an option but there are no study data to guide the dose and frequency of administration. Nonabsorbable rifaximin is now the preferred antibiotic for chemoprophylaxis. The decision to prescribe chemoprophylaxis is a risk-benefit discussion with the patient, weighing underlying disease, the criticality of the trip, the travel destination, potential side effects, concerns for resistance development, and the known benefits of self-therapy without prophylaxis. In addition, emerging data on the effects of antibiotics on the microbiota, concerns for fecal carriage home of antibiotic-resistant organisms after antibiotic use, and potential to prevent irritable bowel syndrome also influence the decision whether to prescribe chemoprophylaxis.
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