clinmedКлиническая медицинаClinical Medicine (Russian Journal)0023-21492412-1339ООО «Медицинское информационное агентство»10.30629/0023-2149-2023-101-2-3-137-140clinmed-516Research ArticleВ ПОМОЩЬ ПРАКТИЧЕСКОМУ ВРАЧУGUIDELINES FOR PRACTITIONERSОсобенности этиологии, клинической картины, диагностики и лечения диареи путешественниковFeatures of etiology, clinical picture, diagnosis and treatment of travelers’ diarrheahttps://orcid.org/0000-0002-1395-9566ШептулинА. А.SheptulinA. A.

Шептулин Аркадий Александрович — д-р мед. наук, профессор кафедры пропедевтики внутренних болезней Института клинической медицины им. Н.В. Склифосовского

119991, Москва

Sheptulin Arkady A.

119991 Moscow

arkalshep@gmail.comhttps://orcid.org/0000-0002-5116-2144КардашеваС. С.KardashevaS. S.

Кардашева Светлана Станиславовна — канд. мед. наук, доцент кафедры пропедевтики внутренних болезней Института клинической медицины им. Н.В. Склифосовского

119991, Москва

Kardasheva Svetlana S.

119991 Moscow

https://orcid.org/0000-0002-6154-8163КурбатоваА. А.KurbatovaA. A.

Курбатова Анастасия Александровна — канд. мед. наук, ассистент кафедры пропедевтики внутренних болезней Института клинической медицины им. Н.В. Склифосовского

119991, Москва

Kurbatova Anastasia A.

119991 Moscow

ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет)РоссияI.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University)Russian Federation2023130420231012-3137140Copyright © Шептулин А.А., Кардашева С.С., Курбатова А.А., 20232023Шептулин А.А., Кардашева С.С., Курбатова А.А.Sheptulin A.A., Kardasheva S.S., Kurbatova A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.clinmedjournal.com/jour/article/view/516

В представленной статье обсуждаются вопросы эпидемиологии, этиологии, клинических проявлений, диагностики, лечения и профилактики диареи путешественников (ДП). Это заболевание чаще всего имеет бактериальную природу, но может вызываться также вирусами и простейшими. ДП чаще всего имеет благоприятное течение и заканчивается самоизлечением. При легких формах ДП достаточным оказывается проведение регидратационной терапии, а также назначение лоперамида или висмута субсалицилата. При умеренно тяжелых и тяжелых формах необходимо применение антибиотиков (фторхинолонов, азитромицина, рифаксимина). Профилактика ДП сводится к соблюдению гигиенических мероприятий. Назначение с этой целью антибиотиков — с учетом растущей устойчивости к ним — проводится лишь по особым показаниям.

The article discusses the issues of epidemiology, etiology, clinical manifestations, diagnosis, treatment and prevention of travelers’ diarrhea (TD). This disease most often has a bacterial nature, but can also be caused by viruses and protozoa. TD usually has a favorable course and ends with self-healing. In mild forms of TD, rehydration therapy is suffi  cient, as well as the appointment of loperamide or bismuth subsalicylate. In moderately severe and severe forms, the use of antibiotics (fl uoroquinolones, azithromycin, rifaximin) is necessary. Prevention of TD is reduced to compliance with hygienic measures. The appointment of antibiotics for this purpose — taking into account the growing resistance to them — is carried out only for special indications.

диарея путешественниковэпидемиологияэтиологиялечениепрофилактикаtravelers’ diarrheaepidemiologyetiologytreatmentpreventionReferencesGiddings S.L., Stevens A.M., Leung D.T. Traveler’s diarrhea. Med. Clin. North. Am. 2016;100(2):317–30. DOI: 10.1016/j.mcna.2015.08.017Giddings S.L., Stevens A.M., Leung D.T. Traveler’s diarrhea. Med. Clin. North. Am. 2016;100(2):317–30. DOI: 10.1016/j.mcna.2015.08.017Leung A.K.C., Leung A.A.M, Wong A.H.C, Hon K.L. Travelers’ diarrhea: a clinical review. Recent Pat. Infl amm. Allergy Drug Discov. 2019;13(1):38–48. DOI: 10.2174/1872213X13666190514105054Leung A.K.C., Leung A.A.M, Wong A.H.C, Hon K.L. Travelers’ diarrhea: a clinical review. Recent Pat. Infl amm. Allergy Drug Discov. 2019;13(1):38–48. DOI: 10.2174/1872213X13666190514105054Fedor A., Bojanowski I., Korzeniewski K. Gastrointestinal infections in returned travelers’. Int. Marit Health. 2019;70(4):244–251. DOI: 10.5603/IMH.2019.0039Fedor A., Bojanowski I., Korzeniewski K. Gastrointestinal infections in returned travelers’. Int. Marit Health. 2019;70(4):244–251. DOI: 10.5603/IMH.2019.0039Barrett J., Brown M. Travellers’ diarrhoea. Brit. Med. J. 2016;353:i1937. DOI: 10.1136/bmjBarrett J., Brown M. Travellers’ diarrhoea. Brit. Med. J. 2016;353:i1937. DOI: 10.1136/bmjShayto R.H., Mrad R.A., Sharara A.I. Use of rifaximin in gastrointestinal and liver diseases. World J. Gastroenterol. 2016;22(29):6638–6651. DOI: 10.3748/wjg.v22.i29.6638Shayto R.H., Mrad R.A., Sharara A.I. Use of rifaximin in gastrointestinal and liver diseases. World J. Gastroenterol. 2016;22(29):6638–6651. DOI: 10.3748/wjg.v22.i29.6638Throckmorton L., Hancher J. Management of travel-related infectious diseases in the emergency department. Curr. Emerg. Hosp. Med. Rep. 2020;8(2):50–59. DOI: 10.1007/s40138-020-00213-6Throckmorton L., Hancher J. Management of travel-related infectious diseases in the emergency department. Curr. Emerg. Hosp. Med. Rep. 2020;8(2):50–59. DOI: 10.1007/s40138-020-00213-6Lopez-Velez R., Lebens M., Bundy L., Barriga J., Steff en R. Bacterial travellers’ diarrhoea: A narrative review of literature published over the past 10 years. Travel Med. Infect. Dis. 2022;47:102293. DOI: 10.1016/j.tmaid.2022.102293Lopez-Velez R., Lebens M., Bundy L., Barriga J., Steff en R. Bacterial travellers’ diarrhoea: A narrative review of literature published over the past 10 years. Travel Med. Infect. Dis. 2022;47:102293. DOI: 10.1016/j.tmaid.2022.102293Taylor D.N., Hamer D.H., Shlim D.R. Medications for the prevention and treatment of travellers’ diarrhea. J. Travel Med. 2017;24(1):S17–S22. DOI: 10.1093/jtm/taw097Taylor D.N., Hamer D.H., Shlim D.R. Medications for the prevention and treatment of travellers’ diarrhea. J. Travel Med. 2017;24(1):S17–S22. DOI: 10.1093/jtm/taw097Danis R., Wawruch M. Travellers’ diarrhoea — prevention, trends and role of microbiome. Cent. Eur. J. Public Health. 2022;30(1):20– 25. DOI: 10.21101/cejph.a6740Danis R., Wawruch M. Travellers’ diarrhoea — prevention, trends and role of microbiome. Cent. Eur. J. Public Health. 2022;30(1):20– 25. DOI: 10.21101/cejph.a6740Riddle M.S., Connor B.A., Beeching N.J., DuPont H.L., Hamer D.H., Kozarsky P. et al. Guidelines for the prevention and treatment of travelers’ diarrhea: a graded expert panel report. J. Travel Med. 2017;24(1):S57–S74. DOI: 10.1093/jtm/tax026Riddle M.S., Connor B.A., Beeching N.J., DuPont H.L., Hamer D.H., Kozarsky P. et al. Guidelines for the prevention and treatment of travelers’ diarrhea: a graded expert panel report. J. Travel Med. 2017;24(1):S57–S74. DOI: 10.1093/jtm/tax026Steff en R., Hill D., DuPont H.L. Traveler’s diarrhea: a clinical review. JAMA. 2015;313(1):71–80. DOI: 10.1001/jama.2014.17006Steff en R., Hill D., DuPont H.L. Traveler’s diarrhea: a clinical review. JAMA. 2015;313(1):71–80. DOI: 10.1001/jama.2014.17006Парфенов А.И. Диарея путешественников. Русский медицинский журнал. 2011;28:177Parfenov A.I. Travelers’ diarrhea. Russian Medical Journal. 2011;28:177. (In Russian)].Ющук Н.Д., Еремушкина Я.М. Диарея путешественников — важная проблема современной медицины. Журнал для непрерывного медицинского образования врачей. 2015;3:87–95.Yushchuk N.D., Eremushkina Yo.M. Travelers’ diarrhea is an important problem of modern medicine. Scientists are still searching new drugs for oral rehydration therapy. Journal for continuing medical ducation of doctors. 2015;3:87–95. (In Russian)].Kantele A., Lääveri T. Extended-spectrum beta-lactamase-producing strains among diarrhoeagenic Escherichia coli-prospective travellers’ study with literature review. J. Travel Med. 2022;29(1):taab042. DOI: 10.1093/jtm/taab042Kantele A., Lääveri T. Extended-spectrum beta-lactamase-producing strains among diarrhoeagenic Escherichia coli-prospective travellers’ study with literature review. J. Travel Med. 2022;29(1):taab042. DOI: 10.1093/jtm/taab042Lääveri T., Sterne J., Rombo L., Kantele A. Systematic review of loperamide: No proof of antibiotics being superior to loperamide in treatment of mild/moderate travellers’ diarrhoea. Travel Med. Infect. Dis. 2016;14(4):299–312. DOI: 10.1016/j.tmaid.2016.06.006Lääveri T., Sterne J., Rombo L., Kantele A. Systematic review of loperamide: No proof of antibiotics being superior to loperamide in treatment of mild/moderate travellers’ diarrhoea. Travel Med. Infect. Dis. 2016;14(4):299–312. DOI: 10.1016/j.tmaid.2016.06.006Pinos Y., Ruiz M.I. Corsi O., Rada G. Is it worth adding loperamide to antibiotic treatment of travelers’ diarrhea? Medwave. 2017;17(Suppl2):e6958. DOI: 10.5867/medwave.2017.6958Pinos Y., Ruiz M.I. Corsi O., Rada G. Is it worth adding loperamide to antibiotic treatment of travelers’ diarrhea? Medwave. 2017;17(Suppl2):e6958. DOI: 10.5867/medwave.2017.6958Riddle M.S., Connor P., Fraser J., Porter C.K., Swierczewki B., Hutley E.J. et al. Trial evaluating ambulatory therapy of travelers’ diarrhea (TrEAT TD) study: A randomized controlled trial comparing 3 single-dose antibiotic regimens with loperamide. Clin. Infect. Dis. 2017;65(12):2008–2017. DOI: 10.1093/cid/cix693Riddle M.S., Connor P., Fraser J., Porter C.K., Swierczewki B., Hutley E.J. et al. Trial evaluating ambulatory therapy of travelers’ diarrhea (TrEAT TD) study: A randomized controlled trial comparing 3 single-dose antibiotic regimens with loperamide. Clin. Infect. Dis. 2017;65(12):2008–2017. DOI: 10.1093/cid/cix693Diptyanusa A., Ngamprasertchai T., Piyaphanee W. A review of antibiotic prophylaxis for travelers’ diarrhea: past to present. Trop. Dis. Travel Med. Vaccines. 2018;4:14. DOI: 10.1186/s40794-018-0074-419Diptyanusa A., Ngamprasertchai T., Piyaphanee W. A review of antibiotic prophylaxis for travelers’ diarrhea: past to present. Trop. Dis. Travel Med. Vaccines. 2018;4:14. DOI: 10.1186/s40794-018-0074-419Andrey S., Droc G. Stefan G. FDA approved antibacterial drugs: 2018-2019. Discoveries (Craiova). 2019;7(4):e102. DOI: 10.15190/d.2019.15Andrey S., Droc G. Stefan G. FDA approved antibacterial drugs: 2018-2019. Discoveries (Craiova). 2019;7(4):e102. DOI: 10.15190/d.2019.15DuPont H.L. Review article: the antimicrobial eff ects of rifaximin on the gut. Aliment Pharmacol. Ther. 2016;43(1):3–10. DOI: 10.1111/apt.13434DuPont H.L. Review article: the antimicrobial eff ects of rifaximin on the gut. Aliment Pharmacol. Ther. 2016;43(1):3–10. DOI: 10.1111/apt.13434Hitch G., Fleming N. Antibiotic resistance in travellers’ diarrhoeal disease, an external perspective. J. Travel Med. 2018;25(1):S27–S37. DOI: 10.1093/jtm/tay014Hitch G., Fleming N. Antibiotic resistance in travellers’ diarrhoeal disease, an external perspective. J. Travel Med. 2018;25(1):S27–S37. DOI: 10.1093/jtm/tay014Fan H., Gao L. Yin Z., Ye S., Zhao H., Peng Q. Probiotics and rifaximin for the prevention of travelers’ diarrhea: A systematic review and network meta-analysis. Medicine (Baltimore). 2022;101(40):e30921. DOI: 10.1097/MD.0000000000030921Fan H., Gao L. Yin Z., Ye S., Zhao H., Peng Q. Probiotics and rifaximin for the prevention of travelers’ diarrhea: A systematic review and network meta-analysis. Medicine (Baltimore). 2022;101(40):e30921. DOI: 10.1097/MD.0000000000030921McFarland L.V., Goh S. Are probiotics and prebiotics eff ective in the prevention of travellers’ diarrhea? A systematic review and metaanalysis. Travel Med. Infect. Dis. 2019;27:11–19. DOI: 10.1016/j.tmaid.2018.09.007McFarland L.V., Goh S. Are probiotics and prebiotics eff ective in the prevention of travellers’ diarrhea? A systematic review and metaanalysis. Travel Med. Infect. Dis. 2019;27:11–19. DOI: 10.1016/j.tmaid.2018.09.007

The authors declare that there are no conflicts of interest present.