American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the most appropriate treatment for otherwise healthy persons with mild travelers' diarrhea?

1. Antibiotic therapy

2. Surgical intervention

3. Fluid replacement with aggressive oral hydration

4. Over-the-counter anti-diarrheal medications

The correct answer is: Fluid replacement with aggressive oral hydration

The most appropriate treatment for otherwise healthy persons with mild travelers' diarrhea is aggressive oral hydration. This condition is often self-limiting and characterized by symptoms such as loose stools, abdominal cramps, and sometimes nausea. The primary concern in cases of diarrhea is the risk of dehydration, particularly in travelers who may not be able to replace lost fluids and electrolytes easily. Oral rehydration solutions (ORS) are preferred because they contain an optimal balance of electrolytes and sugars that help facilitate the absorption of fluids in the intestines. Patients are advised to drink clear fluids, including water, broths, or electrolyte beverages, to maintain hydration. Though antibiotics can be used in more severe cases or in immunocompromised individuals, they are generally not needed for mild travelers' diarrhea, as symptoms are often viral or self-limiting in nature. Similarly, over-the-counter anti-diarrheal medications might not be suitable because they can prolong the duration of diarrhea in cases caused by certain pathogens, particularly if the diarrhea is due to infections that the body needs to eliminate. Surgical interventions are not applicable in this scenario, as travelers' diarrhea typically resolves with conservative management and does not involve any anatomical issues that would require surgery. Therefore, focusing on aggressive