Primary prevention

Primary preventive actions include careful selection of safe food and beverages.[2][22]​ Unsafe items include ice, tap water, salads, previously peeled fruits, and raw foods. Unpackaged condiments and sauces, such as guacamole, often pose a potential risk. Food from street vendors and buffets with poor food turnover also pose a notable risk of food poisoning. Safe items include thoroughly cooked food served while still hot, boiled or bottled (properly sealed) water, commercially packaged foods, fresh breads, and fruits peeled by the traveller. 

Prophylactic antibiotics are not recommended for most travellers.[1][2]​​​ Occasional exceptions include short-term critical itineraries such as diplomatic missions, professional sports, and critical business/life event engagements; and chronically ill or immunocompromised patients on trips of <3 weeks' duration. Rifaximin is considered the treatment of choice for prophylaxis; it is effective at preventing TD with no increase in adverse effects (compared with placebo).[1][23][24][25]​ Rifamycin can also be considered.[2]​ Fluoroquinolones are not recommended for the prophylaxis of TD.[1][2]​ Antibiotic prophylaxis is not usually recommended in children.

There is strong evidence to suggest that bismuth subsalicylate can reduce the incidence of TD by >60%; however, due to the number of tablets required and the inconvenient dosing, it is not commonly used as prophylaxis for TD.[1][26][27]​ Studies have not established the safety of this drug when used for >4 weeks.[1]

Secondary prevention

Avoid high-risk foods and beverages that may be contaminated by bacteria.

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