Travelling in high-risk areas: Antibiotics at all costs?


When travellers take antimicrobials the Risk of Colonization is increasing, is shown in a Finnish study. Co-author Anu Kantele from the Division of Infectious Diseases at the Helsinki University Hospital gives an insight into this survey.

Mrs. Kantele, in the introduction of the study “Antimicrobials Increase Travelers‘ Risk of Colonization by Extended-Spectrum Betalactamase-Producing Enterobacteriaceae” published in “Oxford Journals/Clinical Infection Diseases” states, that there is a danger of transmission to others and to medical care settings when people return home. Is this study the first investigating this phenomenon?

Our study was the first to show with accurate statistics that use of antibiotics predisposes to colonization with multiresistent bacteria. It has been later confirmed by Ruppe et al and others. Travellers‘ diarrhea (TD) as a predisposing factor has been shown in previous studies too.

Travellers tend to take antibiotics when they notice the first signs of diarrhea. Does this disease really always require the intake of antibiotics?

In order to prevent colonization the approaches are to avoid TD and use of antibiotics while travelling in the subtropical and tropical regions where the hygiene is not good and there are lots of resistant bacteria around. Avoiding TD is difficult, but avoiding unnecessary antibiotics depends on the person. TD is the most common cause of antibiotic use yet the disease is usually mild and moderate and does not require antibiotics.

How many people are concerning every year, and what is the danger in this?

Many people transmit the strains to others and to medical care settings when they return home. The spread of resistant bacteria menaces healthcare worldwide, with strains being carried across the globe by international travellers and food and animal trade. Of the more than one billion annual travellers, about 300 million visit the riskiest regions, and more than 20 Percent return home colonized by resistant intestinal bacteria

What could be done to dam this global spread?

Improving hygiene and establishing reasonable antimicrobial policy in high-risk areas cannot be accomplished swiftly. In low-prevalence countries, the battle against the spread of resistant microbes currently focuses on precautions such as surveillance of resistance among bacteria and, in some countries, contact isolation of patients transferred from or hospitalized abroad. Paradoxically, little attention is given to how initial colonization could be prevented while traveling.



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Carola Timmel is journalist for print and radio and professional speaker. Her focus lies on the topic Medicine & Health.

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