Extract

In a recent editorial Keystone and Connor declare in the title: ‘Antibiotic self-treatment of travelers’ diarrhea: it only gets worse.’1 The authors allude to antibiotic-resistant Enterobacteriaceae carriage in stool following antibiotic treatment of travelers’ diarrhea (TD)2,3 and conclude that an antibiotic should no longer be used in the management of mild to moderate TD. The authors allude to a severity scale for diarrhea agreed upon in a Travelers’ Diarrhea Consensus Conference organized by and co-authored by Connor, the results of which had not been published by the time of publication of the Keystone and Connor editorial. By consensus, the definition of mild diarrhea was ‘tolerable’ and moderate TD was ‘distressing’.4 Keystone and Connor (according to their editorial but in contradistinction to the consensus recommendations) prefer not to treat distressing diarrhea with an antibiotic and by default they would apparently prefer to limit antibiotic use to severe or, by the new scale, ‘incapacitating’ diarrhea.

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