Antimicrobial Resistance and Traveler's Diarrhea

February 5, 2020

Mark Riddle, MD, DrPH, speaks to Contagion about preventing drug resistance in people who acquire traveler's diarrhea.

Segment Description: Mark Riddle, MD, DrPH, associate dean of clinical research, University of Nevada, Reno, associate chief of staff for research, VA Sierra Nevada Health System, speaks to Contagion® about preventing drug resistance in people who acquire traveler's diarrhea.

Interview Transcript (modified slightly for readability):

Riddle: We need to understand 2 areas. One is, what is the true impact of these infections on the average individual healthy traveler, how long do they hold it for, what are the health consequences of that?

We also need to understand how the traveler fits in the bigger picture of local community emergence and sustainment of antimicrobial resistance, and global spread. There are lots of sources of antimicrobial resistance spread, the traveler can play a role in that. But, we don't fully understand this and so we need to do studies which help us understand the balance between helping a traveler out who gets sick when they're on vacation or on a mission and the resistance spread globally that this acquisition might have.

That's the big picture. What we're interested in doing is designing a clinical study that really might understand this. Looking at placebo and single dose regimens versus multi-day dose regimens of the same drug in the same place. We believe strongly that there's a dose effect. If you can minimize the dose of antibiotics that you use while you travel and get the same therapeutic effect of stopping your traveler's diarrhea, then we should be doing that. We need more evidence to say that single dose antibiotics work, but also that it doesn't induce this acquisition that we're seeing with these multi-day dose regimens. Those are the next areas of research that we'd like to pursue.

Another area would be—people that acquire these multidrug resistant organisms, we need to be able to screen them and then also get rid of it. There needs to be more emphasis and research and looking at the decolonization, and that would that would be very helpful among not only travelers returning but also hospitalized patients that may be colonizing MDR and reduce the major problem of antimicrobial resistance that we're facing.