These key learning points summarize the consensus- and evidence-based recommendations included in this edition. The sources listed here for each statement recommend that physicians perform or implement these actions directly in a clinical setting.

1. Recommend use of malaria chemoprophylaxis for travelers to endemic regions.
Evidence rating: SORT B
Source: Infectious Diseases Society of America (IDSA), reference 16
Website: https://academic.oup.com/cid/article/43/12/1499/277259

2. Individuals with an unstable medical condition should not fly. Individuals with any significant communicable disease that could be transmitted to other airline passengers (eg, tuberculosis, COVID-19) should postpone travel until they are no longer contagious.
Evidence rating: SORT C
Source: Aerospace Medical Association (AsMA), reference 57
Website: https://www.ingentaconnect.com/content/asma/amhp/2015/00000086/00000007/art00013

3. For mild travelers diarrhea, prescribe oral rehydration salts and, if needed, locally acting antimicrobials (eg, bismuth subsalicylate and/or an antimotility drug [ie, loperamide]). Manage moderate diarrhea (without fever or bloody stools) with an oral antibiotic, such as azithromycin, with or without loperamide. Manage severe diarrhea (with fever or bloody stools) promptly with an antibiotic. Azithromycin is the preferred drug.
Evidence rating: SORT A
Sources: International Society of Travel Medicine (ISTM), Canadian Pharmacists Association (CPhA), references 100 and 104
Websites: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5731448/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610510/

4. For travelers to high-altitude areas, recommend slow ascent and gradual acclimatization to prevent altitude sickness. Strongly consider prescribing acetazolamide (125 mg every 12 hours), or alternatively dexamethasone (2 mg every 6 hours), for altitude sickness prophylaxis for adults at moderate or high risk.
Evidence rating: SORT A
Source: Wilderness Medical Society (WMS), reference 145
Website: https://www.wemjournal.org/article/S1080-6032(19)30090-0/fulltext