Study identifies factors that increase antibiotic use among travelers

Travelers carrying standby antibiotics take them more often than those traveling without such drugs. Having antibiotics packed in the bags allows their use - against recommendations - also for mild and moderate diarrhea, i.e. cases not requiring medication.

Increasing antimicrobial resistance, primarily caused by excessive and uncontrolled use of antibiotics, is a globally recognized severe threat to human health. Returning home, approximately every third traveler to the tropics carries intestinal multiresistant bacteria. The risk of having contracted such bacteria is doubled by taking antibiotics during the journey.

Seeking means to avoid unnecessary antibiotic use, a study was carried out jointly by the University of Helsinki, the Helsinki University Hospital, and the Aava Travel Clinic, aiming to identify factors increasing antibiotic use among travelers.

"To cut down unnecessary antibiotic use, the underlying factors need to be explored," says Anu Kantele, professor at the University of Helsinki and the project lead.

The study comprised 316 prospectively recruited subjects who had contracted travelers' diarrhea during their visit to the tropics. Of the 316 participants, 53 had brought stand-by antibiotics from Finland. The most common reason for antibiotic use was diarrhea, the most prevalent disease among travelers to the tropics, followed by respiratory infections.

As risk factors associated with use of antibiotics, the study identified carriage of stand-by antibiotics, vomiting, diarrhea disrupting or preventing daily activities and contacts with local health care at the destination.

Of those carrying vs not carrying stand-by antibiotics 34% vs 11% resorted to antibiotic therapy. Severe diarrhea was treated with antibiotics similarly in the two groups, yet carriers of stand-by antibiotics also used them for mild and moderate diarrhea. "According to the Finnish guidelines, antibiotics should be used for diarrhea patients with a high fever or an exceptionally severe disease or deteriorating condition, or if they have an underlying disease which may become aggravated," says Kantele.

"In other words, antibiotics should only be used to treat severe diarrhea, whereas for mild and moderate disease fluid therapy and non-antibiotic drugs suffice." Rather than the severity of diarrhea, the factor determining recourse to antibiotics was travelers' subjective experience of disturbance of daily activities.

"Physicians in Finland and elsewhere should give up routinely prescribing antibiotics against travelers' diarrhea," Kantele concludes.

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