Prevention of Traveler's Diarrhea

Abstract

To the Editor.— I am writing in response to the consensus conference on traveler's diarrhea. 1 The most important aspect of traveler's diarrhea is prevention. Although the consensus conference briefly discussed the use of bismuth subsalicylate to prevent enterotoxigenic Escherichia coli -induced diarrhea (ETEC), I do not believe that its true potential role was adequately discussed. The consensus review referred to the study in which Pepto Bismol (58 g, four times daily) decreased the incidence of diarrhea by 60%. 2 There are a number of potential problems in analyzing the results of field trials, particularly performed in an environment with multiple potential pathogens. In that study, ETEC were recovered from patients with diarrhea receiving Pepto Bismol much less frequently than in the control group. These results could be interpreted as showing that the patients who received Pepto Bismol encountered ETEC less frequently by chance, or that there was a specific