Take Our Advice

The April 13, 2015 issue of The Medical Letter includes an article on Advice for Travelers that should be especially useful to our readers and their patients. In just 6 pages, we offer a wealth of information on the prevention and treatment of the common maladies that can spoil a trip, or worse.

Travelers’ diarrhea comes first, as it often does in fact. We recommend a short menu of antimicrobial drugs, with the choice depending on the signs and symptoms of illness and the location of the traveler. We concede that travel medicine experts generally do not recommend prophylaxis for travelers’ diarrhea, but then we describe the types of patients for whom an exception might be made, and proceed to recommend the antimicrobial alternatives that would be suitable for them.

Malaria is a big worry, of course, and a substantial fraction of our article is devoted to it. One table lists all the countries for which prophylaxis is recommended, and a series of footnotes describe the important exceptions, such as no malaria in major urban areas. A second table lists the drugs of choice for prevention of malaria with their doses and duration of use. Here too, our footnotes, developed over decades with the help of the CDC and the world’s malaria experts, fill in the information all of us need to properly inform our patients on their way to areas where they will be at risk.

And there is more: insect bites, for example, and how to avoid them, including everything you ever wanted to know about which concentration of DEET to use. And to prepare those travelers who climb the high mountains, we have an excellent section on how to avoid acute altitude illness. How to prevent venous thromboembolism on the airplane, jet lag on arrival, motion sickness on the cruise ship, and sunburn while lounging on its deck, all are included in this short compendium.

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