Issue 4/2026
Kotsev, I.
Military Medical Academy, Varna Hospital, Gastroenterology Clinic – Varna
Traveler‘s diarrhea (TD) occurs within two weeks of traveling to an area with poor public hygiene, caused by consumption of food and water contaminated with bacteria, viruses, or parasites. It usually resolves without treatment within a few days, and a possible complication is dehydration. The most common risk factors for TD are: traveling to low-resource countries, poor public hygiene, lack of refrigerators and freezers, lack of safe drinking water, irregular electricity supply, inadequate thermal processing of food, poor food storage. Risk factors related to the traveler‘s personal characteristics are: use of proton pump inhibitors, recent use of antibiotics, unprotected sexual practices, high alcohol consumption (more than 5 drinks/day of 25 g). The risk for developing a complicated form of TD includes: childhood or old age, pregnancy, comorbid gastrointestinal diseases, immunocompromised status. Travelers’ diarrhea (TD) is defined as the occurrence of at least three unformed stools in 24 hours along with at least one of the following additional symptoms: abdominal pain, nausea, vomiting, urgent need to defecate, elevated temperature, and hematochezia. To minimize the risk of developing TD, travelers should avoid drinking tap water and ice, should not eat leafy vegetables and unpeeled fruits, should avoid street food, and eat only thermally processed food. There are reports that the prophylactic use of bismuth preparations reduces the incidence of TD, but bismuth is not given to children and pregnant women. Rifaximin and Rifamycin are the most commonly used chemotherapeutic prophylactic agents as they have minimal systemic absorption and very few side effects.
Today it is believed that preventive antibiotic use during travel is not necessary, but for high-risk travelers, for those who will have difficulty adhering to hygiene measures and dietary restrictions, as well as in immunosuppressed traveling patients, the prophylactic use of antibiotics can be applied. It is advisable for all travelers to have antibacterial agents to use when needed.
Adress for correspondence:
Prof. I. Kotsev, MD
Military Medical Academy, Varna Hospital,
Clinic of Gastroenterology, Varna
3, „Hristo Smirnenski”, Str.
9000, Varna
e-mail: iskren_kotzev@abv.bg