American Board of Internal Medicine (ABIM) Certification Practice Exam

When should antibiotics be considered for travelers' diarrhea?

1. Only in severe dehydration cases

2. When there are more than four unformed stools per day with fever and blood in stools

3. After two days of intensive hydration

4. In all cases of diarrhea

The correct answer is: When there are more than four unformed stools per day with fever and blood in stools

Antibiotics should be considered for travelers' diarrhea primarily when a patient presents with more than four unformed stools per day, along with accompanying symptoms such as fever and the presence of blood in the stools. This combination of factors often indicates a more severe infection that might be caused by a bacterial pathogen, which is likely to benefit from antibiotic treatment. In cases of travelers' diarrhea that are characterized by numerous unformed stools and systemic symptoms like fever, the risk of a more serious gastrointestinal infection, such as those caused by pathogens like Shigella or certain strains of E. coli, increases. Antibiotics can help shorten the duration of symptoms and reduce the severity of the disease, preventing complications that could arise from prolonged infection or dehydration. Severe dehydration alone doesn't warrant antibiotic treatment unless it is accompanied by the signs mentioned. Treating travelers' diarrhea should focus on symptom severity, clinical presentation, and associated signs of infection. Hydration is crucial in all cases of diarrhea, but waiting two days of intensive hydration without considering the clinical context might lead to unnecessary delays in appropriate treatment, particularly in those who are experiencing significant symptoms. Lastly, not all cases of diarrhea require antibiotic therapy; many cases are self-limiting and can be managed with supportive care alone,