Outcomes of diarrhea management in operations Iraqi Freedom and Enduring Freedom

Brown, Jamey A.; Riddle, Mark S.; Putnam, Shannon D.; Schlett, Carey D.; Armstrong, Adam W.; Jones, James J.; Tribble, David R.; Sanders, John W.

doi:10.1016/j.tmaid.2009.09.001

« Previous Next »Travel Medicine and Infectious Disease
Volume 7, Issue 6 , Pages 337-343, November 2009

Outcomes of diarrhea management in operations Iraqi Freedom and Enduring Freedom

Jamey A. Brown
- Womack Army Medical Center, Fort Bragg, NC, USA
Mark S. Riddle
- Naval Medical Research Center, Enteric Diseases Department, Silver Spring, 503 Robert Grant Ave., MD 20910, USA
- Corresponding author. Tel.: +1 301 319 7686; fax: +1 301 319 7673.
Shannon D. Putnam
- U.S. Naval Medical Research Unit No. 2, Jakarta, Indonesia
Carey D. Schlett
- U.S. Naval Medical Research Unit No.3, Cairo, Egypt
Adam W. Armstrong
- U.S. Naval Medical Research Unit No.3, Cairo, Egypt
James J. Jones
- Army Central Command, Troop Medical Clinic, Doha, Qatar
David R. Tribble
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
John W. Sanders
- Naval Medical Research Center Detachment, Lima, Peru

Received 27 February 2009; received in revised form 25 August 2009; accepted 2 September 2009. published online 05 October 2009.

Summary

Introduction

Among deployed U.S. military personnel, a sub-population of international travelers, acute infectious diarrhea continues to be a leading cause of morbidity and a potential threat to military effectiveness.

Methods

To assess outcomes and satisfaction of diarrhea management in the field, a systematic survey was given to military personnel during mid- or post-deployment from Iraq or Afghanistan, from January through August 2004.

Results

Sixty-three percent of those surveyed reported at least one episode of diarrhea, while less than half sought care for their symptoms. Overall, trends of decreased post-treatment duration were noted as traveler's diarrhea therapy modalities grew more complex, controlling for severity of illness at presentation. Among those reporting diarrhea, the greatest level of satisfaction was seen in treatment with IV fluids (59%) followed by antibiotics (46%) and loperamide (40%). The greatest amount of dissatisfaction was seen in treatments with oral fluids only.

Conclusion

While current standard of care is self-treatment of diarrhea in civilian travelers, the U.S. military lacks standards outlining self-treatment of personnel at the individual level. Further research is needed to develop treatment guidelines on diarrhea management during military deployment.

Keywords: Travelers' diarrhea, Empiric therapy, U.S. military, Middle East