In pregnancy trimethoprim alone can be used and has been shown to be quite effective in the treatment of travellers' diarrhea, but not in its prevention. Tetracycline and the quinolones are contraindicated in pregnancy. TMP-SMX can be safely used up to the last month of pregnancy, but the treating physician and the patient should be aware of the risk of kernicterus when sulpha drugs are used late in pregnancy. In all cases of diarrhea fluid replacement is recommended. A 3-day course of an antibiotic is conventional.
Prevention is effected by judicious choice of food and water.
Only a minority of such short-term travellers will develop diarrhea. The greater the number of antimicrobial recipients, the greater the number of adverse effects, including allergy, photosensitivity reaction, antibiotic-associated diarrhea and vaginal candidiasis. Antibiotic prophylaxis has not been shown to prevent diarrhea in travellers with achlorhydria or with prior gastrectomy, or in patients particularly likely to suffer from acute diarrhea. It has not been shown to prevent enteric infection in patients with AIDS or other immunodeficiency, nor to inhibit systemic dissemination of Salmonella or other enteric organisms. They have increased susceptibility to diarrhea because of achlorhydria, prior gastrectomy or poor history on previous trips.