Background. Travelers’ diarrhea (TD) is the most prevalent disorder affecting travelers to developing countries. Thailand is
considered ‘‘moderately risky’’ for TD acquisition, but the risk by city visited or behavior of the visitor has yet to be definitely
defined. Restaurant eating is consistently associated with the acquisition of diarrhea while traveling, and pathogen-free meals serve
as a marker of public health success. This study seeks to ascertain a traveler’s risk of exposure to certain bacterial gastric pathogens
while eating at Bangkok restaurants recommended in popular tourist guide books.
Methods. A cross-sectional tourist restaurant survey was conducted. Thirty-five restaurants recommended in the two top selling
Bangkok guidebooks on Amazon.com were sampled for bacterial pathogens known to cause diarrhea in Thailand, namely
Salmonella, Campylobacter, and Arcobacter (a Campylobacter-like organism). A total of 70 samples from two meals at each restaurant
were obtained. Suspected bacterial pathogens were isolated by differential culture and tested for antibiotic resistance.
Results. Salmonella group E was isolated from one meal (2%), and Arcobacter butzleri from nine meals (13%). Campylobacter spp.
were not found. The large majority of A butzleri isolates were resistant to azithromycin but susceptible to ciprofloxacin and an
aminoglycoside.
Conclusions. A traveler’s risk of exposure to established bacterial pathogens, Salmonella and Campylobacter, by eating in
recommended restaurants is small. Arcobacter butzleri exposure risk is 13% per meal eaten, and rises to 75% when 10 meals
are eaten. All restaurants, regardless of price, appear to be equally ‘‘risky.’’ Current evidence points to Arcobacter being pathogenic
in humans; however, further research is needed to conclusively define pathogenicity. Routine prophylaxis for diarrhea is not
recommended; however, travelers should be aware of the risk and come prepared with adequate and appropriate self-treatment
medications.