Traveler's diarrhea - Emerging treatments

Hyperimmune bovine colostrum

Hyperimmune bovine colostrum is designed to help prevent and reduce the symptoms of TD. Hyperimmune bovine colostrum contains antibodies against common enterotoxigenic Escherichia coli (ETEC) strains, which are a common cause of TD. One randomized, double-blind, placebo-controlled study is being conducted to evaluate the efficacy and safety of this product in healthy adult volunteers who have moderate to severe diarrhea after being challenged with ETEC strain H10407.[42]

Prebiotics and probiotics

Prebiotics are nondigestible oligosaccharides that stimulate the growth of probiotic microbes such as Lactobacillus and Bifidobacterium in the gut. Probiotics include gut bacteria or yeasts that are believed to augment or modify the host's microbiome and reduce the colonization by pathogens or reduce the virulence of acquired pathogens. There is some evidence to suggest that probiotics provide a protective effect against antibiotic-associated diarrhea among children.[43] [ ] However, research into the use of probiotics and prebiotics for preventing or treating TD is inconclusive, and the subject remains controversial.[1] Although the evidence for their effectiveness in preventing TD is disputed, most travel clinicians do not discourage probiotic use as long as a back-up antibiotic is available. The Centers for Disease Control and Prevention (CDC) states: 'probiotics (e.g., Lactobacillus GG, Saccharomyces boulardii) have been studied in small numbers of people as TD prevention, but results are inconclusive, partly because standardized preparations of these bacteria are not reliably available. Studies of probiotics to prevent TD are ongoing, but data are insufficient to recommend their use'.[2]

Cholera vaccine

There are two main groups of oral cholera vaccines (OCVs) globally available: killed (kOCV) and live OCV. Cholera in travelers is very rare and first-line antibiotics provided for stand-by empiric therapy are effective in treatment. Cholera vaccine is not routinely recommended for most travelers. Although still very rare, cholera appears to be more common in travelers who are visiting friends and relatives, and in those performing humanitarian aid work in outbreak settings. These groups may have longer stays and limited access to safe food and water. In these situations, vaccination against cholera may be considered. Vaxchora®, a live OCV, is available in the US. Dukoral® , a kOCV, is available in Europe and Canada.

Diosmectite

Diosmectite is an antidiarrheal absorbent natural clay. One Cochrane review, based on low-certainty evidence, found that smectite (diosmectite) may reduce the duration of diarrhea in children with acute infectious diarrhea by one day when used as an adjuvant to rehydration therapy.[44] A popular antidiarrheal in China, diosmectite is approved in the European Union, but is not yet approved for use in the US.