Helsinki, Finland—During vacation season, travelers often seek “standby” antibiotics from their physicians, at least partly to avoid having to visit to local healthcare providers, especially in exotic or less-traveled locations.

The practice is not harmless, however, according to a new study in the journal Travel Medicine and Infectious Disease, which warns that globe-trotters with standby antibiotics are more likely to overuse or misuse the drugs.

As an example, University of Helsinki researchers and colleagues point out that the antibiotics are often taken for mild-to-moderate diarrhea, which does not require that treatment.

The study also points out that, upon return home, a third of the travelers are carrying intestinal multiresistant bacteria, and that taking antibiotics doubles that risk.

“To cut down unnecessary antibiotic use, the underlying factors need to be explored,”said lead researcher Anu Kantele, MD, PhD, professor at the University of Helsinki.

Study authors focused on 316 prospectively recruited subjects who had contracted travelers’ diarrhea during their visit to the tropics. Of those, 53 had brought standby antibiotics from Finland; with diarrhea was the most common reason for antibiotic use, followed by respiratory infections.

The study found that of travelers with standby antibiotics versus those without, 34% versus 11%, respectively, resorted to antibiotic therapy. An issue was that, while severe diarrhea was similarly treated with antibiotics in the two groups, patients with standby antibiotics also used the drugs for mild and moderate diarrhea, which was unnecessary.

“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,” Kantele pointed out, adding, 

“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.” 

She suggested that travelers often were more concerned about interference with their daily activities than with the severity of their gastrointestinal distress. The result, according to Kantele: “Physicians in Finland and elsewhere should give up routinely prescribing antibiotics against travelers’ diarrhea.”

“Carriage of stand-by antibiotics encouraged less cautious use of antibiotics. Recommendations involving prescription of antibiotics for all travelers require urgent revision,” the study adds.

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