Stand-by antibiotics encourage unwarranted use for travellers’ diarrhea

When you carry antibiotics on your travels, it’s more likely that you will take them when you get travelers’ diarrhea, than when you do not have antibiotics with you. This is shown by a recent study by Vilkama et al. carried out jointly by the University of Helsinki, the Helsinki University Hospital, and the Aava Travel Clinic[1].

Travelers’ diarrhea, antibiotics and antimicrobial resistance

It’s summer season in Europe and likely that you will enjoy a well-deserved holiday soon. A downside of a holiday in a foreign country (yes, there is a downside) can be travelers’ diarrhea (TD). The most common cause of TD worldwide is the bacterial pathogen enterotoxigenic Escherichia coli (or ETEC). Getting TD depends on: who you are, where you go, when you travel, where you stay, and what you do[2]. TD is essentially benign and often self-limiting, nevertheless antibiotics are traditionally the main treatment in more severe cases of TD and even used as prophylaxis. At present, treatment of TD by antibiotics is hotly debated due to the increase in antimicrobial resistance.

Less antibiotics

To cut down unnecessary antibiotic use, one has to figure out the exact reasons why travelers take antibiotics, the researchers argued. Therefore they carried out a prospective study.

Data collection and method

The researches revisited the data of 316 subjects from a previous study who developed travelers' diarrhea. These data were collected by questionnaires and health diaries and included the following variables: antibiotic use, stand-by antibiotic carriage and visits to local healthcare providers. To assess the relationship between these variables – or as phrased above: to identify the exact reasons to take antibiotics – a specific statistical method was used (the multivariable analysis).

Carriers and non-carriers of antibiotics

Of the 316 people, 266 were suitable for analysis, whereof 53 carried stand-by antibiotics (the so called ‘carriers’) and 213 did not (the non-carriers). Antibiotic use turned out to be more frequent among the carriers (34%) than among non-carriers (11%). The analysis showed that everyone took antibiotics, carrier or not, if they suffered from severe or even incapacitating traveler’s diarrhea. However, in case of mild/moderate diarrhea 38% of the carriers took antibiotics compared to only 4% of the non-carriers. The scientists concluded that carriage of stand-by antibiotics encouraged less cautious use of antibiotics.

Probiotics and travelers’ diarrhea

In the quest for alternatives for unnecessary antibiotics use, probiotics may be a good answer. Probiotics have been suggested as a safe and effective method to prevent TD[3]. Moreover, considering the microbiome as the interface with the external world of the traveler[4], Winclove suggests to support the microbiome during traveling with a probiotic formulation like Winclove Travel or Winclove 505. For more information on these formulations contact: Sales Department.

“Boil it, cook it, peel it – or forget it” is the most common dietary advice to prevent TD. However compliance to this advice is low, and therefore probiotics have been suggested as a safe and effective method to prevent TD.


1. Vilkman K, Laaveri T, Pakkanen SH, Kantele A. Stand-by antibiotics encourage unwarranted use of antibiotics for travelers' diarrhea: A prospective study. Travel medicine and infectious disease 2018.

2. Al-Abri SS, Beeching NJ, Nye FJ. Traveller's diarrhoea. The Lancet Infectious diseases 2005;5:349-60.

3. McFarland LV. Meta-analysis of probiotics for the prevention of traveler's diarrhea. Travel medicine and infectious disease 2007;5:97-105.

4. Riddle MS, Connor BA. The Traveling Microbiome. Curr Infect Dis Rep 2016;18:29.