8 days) than in the previous study. These two factors, as well as the fact that our research was conducted during the summer peak, may led to the higher incidence rate of diarrhea, as found in several studies.15–17 Although up to 90% of our backpackers perceived the risk of travelers’ diarrhea while traveling in Southeast Asia, their actual practices were far from ideal. Up to 95.7% of participants had bought food from street vendors, 92.5% had drunk beverages with ice-cubes, 34.6% had eaten leftover food from a previous meal, and 27.5% had drunk tap water. These low compliance rates with safe behaviors have been found in many studies.10,18 We were unable to

selleck kinase inhibitor demonstrate any relationship between each practice and diarrheal attack, except for drinking beverages with ice/ice-cubes, which was more common in the diarrheal group than the nondiarrheal group. As in all cross-sectional studies, Inhibitor Library screening we could not assess the causal relationship between these two parameters. Unfortunately, even longitudinal studies have failed to show that adherence to sensible practices will reduce the risk of diarrhea.18–21 More than half of our participants carried some

kind of antidiarrheal medication. Most (71%) carried antimotility medications; although their efficacy, that is, their ability to reduce the number of stools passed, has been proven,22 they should be used with care, especially when used alone for diarrhea associated with high fever, chills, or bloody mucus diarrhea.4 Antimotility medications may actually worsen the clinical course of invasive diarrhea,23 so that antibiotic treatment should be considered. Unfortunately, we did not assess backpackers’ knowledge of when and how to use antimotility medications appropriately. Most episodes of travelers’ diarrhea

in our series were mild; about 80% of diarrheal episodes caused <6 bowel movements per day, and lasted <4 days. Most cases recovered spontaneously, with only 3.2% Non-specific serine/threonine protein kinase needing hospitalization. These general characteristics of travelers’ diarrhea in our study were well-matched with most previous studies.4,9,24 Although it may seem a mild disease, its nonmedical impacts should not be neglected. Diarrheal episodes can force a significant number of travelers (11.3% in our study, to 40% in some reports4,17) to delay or cancel their trip, incurring additional expense. The lower levels of impact reported in our study may be due to the particular characteristics of backpackers, that is, that they usually have more flexible itineraries than general or business travelers. This study had several limitations. First, our data collection was done exclusively in Khao San Road area. Although it is a well-known, main backpacker hub in Southeast Asia, data from single site could not be a perfect representative of the whole backpacker group in the region. Apart from that, our data collection was done only in summer time and seasonality may have affected the incidence of travelers’ diarrhea.