Antimicrobial Stewardship and the Treatment of Travelers’ Diarrhea: Is it Time to Re-think Recommendations?

Diarrhea is common among those visiting developing countries and is the most frequent travel related illness. Multiple guidelines suggest travelers’ diarrhea should be treated with antimicrobials. Self-treatment with antibiotics has been shown to shorten illness by 1–2 days but not without the potential risk of side effects. This treatment also needs to be balanced with the impact of antimicrobial pressure on the generation of resistance. In the era of antimicrobial stewardship, and with increasing global resistance among many different pathogens including those causing travelers' diarrhea, perhaps the recommendations for self-treatment should be re-examined. In this review we will examine the question; is the modest improvement in symptoms in an otherwise self-limiting illness worth the antimicrobial pressure?