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Additionally, there is minimal evidence for a correlation between adherence to dietary precautions and a reduced risk of TD,13 although common sense nevertheless supports care with food selection. Use of antibacterial handwash before eating is also recommended.
Immunisation has little practical role in the prevention of TD and the only potentially relevant vaccines are those against rotavirus infants only and the oral cholera vaccine.
Other vaccines directed against organisms spread by the faecal—oral route are the vaccines for typhoid, hepatitis A and polio, but infection with these organisms rarely causes TD.
Several probiotic agents have been studied for treatment and prevention of TD, including Lactobacillus and Saccharomyces preparations.
However, their effectiveness for TD prevention has been limited, and a consensus group has recommended against their use.
Should antibiotic prophylaxis against TD be given? Other options include the antibiotics discussed below for TD self-treatment.
How should self-treatment of TD be managed?
The first goal of therapy is the prevention and treatment of dehydration, which is of particular concern for young children, pregnant women and the elderly.
Commercial packets of oral rehydration salts are readily available in pharmacies and should be purchased before travel. The other element of TD self-treatment is to recommend travellers bring an antimotility agent plus an antibiotic with them.
When should loperamide alone versus loperamide plus an antibiotic be taken? For mild symptoms of watery diarrhoea, self-treatment with oral rehydration plus loperamide is recommended.
Loperamide therapy alone has no untoward effects in mild TD 18 but if symptoms worsen, or do not improve after 24 hours, antibiotics should be added.Special Situations M eningitis H has often not been fully established.
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