travellers diarrhoea gp notebook

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Traveller's diarrhoea

• Overview  
• Theory  
• Diagnosis  
• Management  
• Follow up  
• Resources  

Traveller's diarrhoea is a common problem among travellers to destinations with deficiencies in water, sanitation, and hygiene (WASH) infrastructure, typically caused by the consumption of contaminated food or water. Predominantly caused by bacteria.

Prevention strategies include careful selection of food and beverages, though these are not fail-safe. Prophylactic antibiotics are not recommended for most travellers.

Management is self-diagnosis while still travelling, followed by hydration, medicine for symptom relief, and possibly, antibiotics. Antibiotic therapy is generally reserved for moderate to severe infections.

In healthy patients, resolution is typically within 3-5 days even without antibiotic treatment.

Traveller's diarrhoea (TD) is defined as ≥3 unformed stools in 24 hours accompanied by at least one of the following: fever, nausea, vomiting, cramps, tenesmus, or bloody stools (dysentery) during a trip abroad, typically to a destination with deficiencies in water, sanitation, and hygiene (WASH) infrastructure. It is usually a benign, self-limited illness lasting 3-5 days.

History and exam

Key diagnostic factors.

• presence of risk factors
• diarrhoea (with or without tenesmus), cramping, nausea, and vomiting
• dysentery (blood and fever)
• persistent diarrhoea >14 days

Other diagnostic factors

• diarrhoea without illness

Risk factors

• travel to a high-risk destination
• age <30 years
• proton-pump inhibitor use
• travellers with prior residence in higher-risk destination visiting friends and relatives
• travel during hot and wet seasons
• deployed military populations
• lack of caution in food and water selection

Diagnostic investigations

1st investigations to order.

• stool culture and sensitivity
• multi-pathogen molecular diagnostic (polymerase chain reaction)
• protozoal stool antigens

Investigations to consider

• stool ova and parasite examination
• Clostridioides difficile stool toxin
• colonoscopy, endoscopy, and biopsy
• haematology, blood chemistries, serology

Treatment algorithm

Pre-travel prophylaxis, non-pregnant adults: mild diarrhoea, non-pregnant adults: moderate diarrhoea, non-pregnant adults: severe diarrhoea, contributors, daniel t. leung, md, msc.

Associate Professor

Division of Infectious Diseases

University of Utah School of Medicine

Salt Lake City

Disclosures

DTL receives authorship royalties from UpToDate, Inc, for a chapter on travel medicine. DTL is an author of upcoming chapters on traveller's diarrhoea for the US CDC Yellow Book. DTL is the president-elect of the American Committee on Clinical Tropical Medicine and Travelers' Health - Clinical Group within the American Society of Tropical Medicine and Hygiene. DTL is an author of some of the references cited in this topic.

Jakrapun Pupaibool, MD, MS

JP declares that he has no competing interests.

Acknowledgements

Dr Daniel T. Leung and Dr Jakrapun Pupaibool would like to gratefully acknowledge Dr Mark Riddle and Professor Gregory Juckett, the previous contributor to this topic.

MR has given talks on the management of traveller's diarrhoea for the International Society of Travel Medicine (ISTM), the CDC Foundation, the American College of Gastroenterology (ACG), and the American College of Preventive Medicine. MR has led the development of guidelines for traveller's diarrhea for the ISTM, the ACG, and the Department of Defense. This work has been unpaid but support for travel has been accepted. MR is employed with Pfizer Inc., and is working on their Lyme disease vaccine programme. While this is not in conflict with traveller’s diarrhoea, Pfizer also makes azithromycin, which is an antibiotic recommended for the treatment of traveller’s diarrhoea. MR does not work in the area of Pfizer that develops, markets, or distributes azithromycin. MR is an author of several references cited in this topic. GJ declares that he has no competing interests.

Peer reviewers

Andrea summer, md.

Assistant Professor of Pediatrics

Medical University of South Carolina

AS declares that she has no competing interests.

Phil Fischer, MD

Professor of Pediatrics

Department of Pediatric and Adolescent Medicine

Mayo Clinic

PF is an author of a reference cited in this topic.

Differentials

• Food poisoning
• Irritable bowel syndrome
• Secondary disaccharidase (or other dietary) deficiency
• CDC Yellow Book 2024: travelers' diarrhea
• 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea

Patient leaflets

Diarrhoea in adults

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• Management of...

Management of travellers’ diarrhoea

• Related content
• Peer review
• David R Hill , director, honorary professor 1 ,
• Edward T Ryan , director, associate professor 2
• 1 National Travel Health Network and Centre, and London School of Hygiene and Tropical Medicine, Hospital for Tropical Diseases, London WC1E 6JB
• 2 Travelers’ Advice and Immunization Center, and Tropical and Geographic Medicine Center, Massachusetts General Hospital, Boston, USA
• Correspondence to: D R Hill david.hill{at}uclh.org

Travellers’ diarrhoea is one of the most common illnesses in people who travel internationally, and depending on destination affects 20-60% of the more than 800 million travellers each year. In most cases the diarrhoea occurs in people who travel to areas with poor food and water hygiene. 1 This review examines the approach to the prevention and treatment of diarrhoea in travellers. Much of the evidence base for travellers’ diarrhoea has been established over the past 30 years, with a strong body of randomised trials and consensus opinion in support of recommendations. The use of antibiotics for self treatment or chemoprophylaxis, however, remains debatable.

Sources and selection criteria

We identified articles through an electronic search of PubMed and the Cochrane library using the term “travelers’ diarrhea” alone and in combination with “treatment”, “etiology”, and “prevention”. Additional studies were sourced from the retrieved articles. We also reviewed our extensive collection of articles on the subject, as well as current national guidelines in travel medicine.

Summary points

Travellers’ diarrhoea affects 20-60% of people travelling primarily to low income regions

Classic travellers’ diarrhoea is defined as three or more loose stools in 24 hours with or without at least one symptom of cramps, nausea, fever, or vomiting

Bacteria cause most identified cases; however, viruses and protozoan parasites are also causative

The objectives of self treatment are to avoid dehydration, reduce the symptoms and duration of illness, and prevent disruption to planned activities

Travellers should maintain hydration, and can use bismuth subsalicylate to treat mild diarrhoea, loperamide to control symptoms when necessary, and a short course of an antibiotic to treat moderate to severe cases

Evaluation and management of returned travellers with diarrhoea includes maintaining hydration during mild illness, bacterial culture of stools and empirical treatment during moderate to severe illness, and, in protracted cases, examination of stools for ova and parasites

What is travellers’ diarrhoea?

Classic travellers’ diarrhoea is defined as at least three loose to watery stools in 24 hours with or without one or more symptoms of abdominal cramps, fever, nausea, vomiting, or blood in the stool. Mild to moderate diarrhoea is one or two loose stools in 24 hours with or without another enteric symptom. The median time to onset is six or seven days after arrival. Although the diarrhoea often resolves spontaneously over three or four days, up to a quarter of affected travellers need to alter their plans, interrupting their holiday or business activities. 2

What causes travellers’ diarrhoea?

The causes of travellers’ diarrhoea depend on the destination, setting, and season, although studies have been done in only a limited number of countries (table 1 ⇓ ). 3 4 Enteric bacteria are documented as the most common causes: several types of Escherichia coli and Campylobacter , Salmonella , and Shigella spp; Vibrio cholerae is rare in travellers. Enterotoxigenic E coli that produce a heat labile or heat stable toxin are the most common species of E coli implicated, with enteroaggregative E coli increasingly recognised. 5 Enterohaemorrhagic E coli (producing shiga toxin or vero cytotoxin) are not typically described in travellers. Enterotoxigenic E coli predominates in travellers to Latin America but is also seen globally. Rates of Campylobacter infection per traveller are highest in those visiting South Asia and South East Asia, 6 exceeding those of enterotoxigenic E coli in some studies.

 Causes of travellers’ diarrhoea

• View inline

Norovirus and rotavirus are the most commonly identified viral causes of travellers’ diarrhoea, although these agents have not been uniformly examined. 7 Norovirus is often associated with outbreaks of diarrhoea in holiday resorts or on cruise ships. Parasites are less common causes of travellers’ diarrhoea; of these, the protozoa Giardia intestinalis and Cryptosporidium are most commonly identified. 8 Cyclospora and Entamoeba histolytica are less common causes, and typically associated with long term travel. In 10-15% of cases more than one pathogen is identified, and in up to 50% of studies no pathogen is described. 4 9 Acute food poisoning—the sudden onset of nausea, vomiting, and diarrhoea after ingestion of a toxin (usually produced by Staphylococcus aureus , Bacillus cereus , or Clostridium perfringens ) in food that has not been properly cooked or stored, accounts for up to 5% of cases.

What are the consequences of having travellers’ diarrhoea?

As the causes of travellers’ diarrhoea are multiple the clinical features vary: from the typical watery stools with cramping and nausea associated with enterotoxigenic E coli , to dysentery with Shigella , to short lived nausea, vomiting, and diarrhoea associated with acute food poisoning or norovirus. Although most cases resolve without treatment over several days, in about 10% the symptoms persist for more than a week, and in about 2% for more than a month. 2 About one quarter of travellers alter their plans because of diarrhoea, and about 5% seek medical care. 2 Illness tends to be more severe in infants and young children, and precautions should be taken to deal with a potentially dehydrating diarrhoeal illness in children when travelling. Serious complications include haemolytic uraemic syndrome with bacteria that produce shiga toxin, Guillain Barré syndrome with Campylobacter , and post-infectious arthropathies with any invasive bacteria. Prolonged illness (>10 days), illness that begins after return, and illness associated with weight loss are more likely to be caused by protozoan parasites such as Giardia .

Irritable bowel syndrome can occur after travellers’ diarrhoea. In two prospective observational studies, travellers who had diarrhoea were more likely to have a new diagnosis of irritable bowel syndrome at six months after return. 10 11

How can travellers’ diarrhoea be prevented?

Food, water, and personal hygiene.

Travellers’ diarrhoea is acquired through the ingestion of contaminated food and water, therefore strict food, water, and personal hygiene precautions should decrease the risk (see box). Despite an increased understanding of the causes and pathogenesis of travellers’ diarrhoea, its incidence has not substantially decreased over the past few decades, and travellers who practise preventive measures do not always have a lower incidence of the condition. The risk of travellers’ diarrhoea increasingly seems related to the sanitation level at the destination rather than the ability to adhere to avoidance measures. 12 13 14 15

Diet and personal hygiene measures to prevent travellers’ diarrhoea

Foods and beverages to be avoided.

Raw or undercooked meats, fish, and seafood

Unpasteurised milk, cheese, ice cream, and other dairy products

Tap water and ice cubes

Cold sauces and toppings

Ground grown leafy greens, vegetables, and fruit

Cooked foods that have stood at room temperature in warm environments

Food from street vendors, unless freshly prepared and served piping hot

Hygiene measures

Render water potable by either bringing it to a boil or treating it with chlorine or iodine preparations* and filtering with a filter of 1 µm or less

Wash hands before eating

*Protozoan parasites are relatively resistant to chlorine and iodine. Contact time should be extended for cold or turbid water

No single vaccine prevents travellers’ diarrhoea, because of the multiple potential causes. Enteric vaccines prevent rotavirus (being introduced into childhood immunisation programmes), hepatitis A, typhoid, and cholera and such vaccines can be given when indicated after a careful risk assessment based on destination and itinerary.

Some enterotoxigenic E coli strains express a heat labile enterotoxin that is similar to cholera toxin produced by V cholerae . Consideration has therefore been given to using the oral killed cholera vaccine (Dukoral; Crucell, Leiden), which contains a non-toxic portion of cholera vaccine, to induce cross protective immunity against enterotoxigenic E coli . Up to 50% of enterotoxigenic E coli strains do not, however, express heat labile enterotoxin, and an analysis of studies suggests that using oral killed cholera vaccine would prevent only 1-7% of people from developing travellers’ diarrhoea, depending on destination and frequency of heat labile producing entertoxigenic E coli . 16 In a phase II trial, vaccination of travellers with heat labile enterotoxin using a transcutaneous delivery system showed 75% protective efficacy against all cause moderate to severe diarrhoea (defined as ≥4 stools in 24 hours). 17 Although no difference was found in the overall incidence of diarrhoea between the recipients of the vaccine and those of placebo, vaccine recipients had fewer stools and a shorter duration of illness.

Chemoprophylaxis

Chemoprophylaxis comprises two approaches: the use of non-antibiotic products (bismuth subsalicylate and probiotics) and the use of antibiotics. Bismuth subsalicylate (preferably in tablet form) provides about 60% protection against travellers’ diarrhoea; however, adverse events may be common at the most effective doses. 18 A meta-analysis suggests that probiotics can lessen the likelihood of travellers’ diarrhoea by about 15%. 19

Although several randomised placebo controlled studies in the 1970s and ‘80s showed antibiotic prophylaxis to be effective in preventing travellers’ diarrhoea, it is not currently recommended for most travellers for several reasons: the potential adverse events associated with prophylactic antibiotics, predisposition to other infections such as vaginal candidiasis or Clostridium difficile associated disease, development of bacterial resistance, cost, and lack of data on the safety and efficacy of antibiotics given for more than two or three weeks. 20 In addition, the highly efficacious nature of early self treatment of travellers’ diarrhoea further dampens enthusiasm for chemoprophylaxis with antibiotics.

Expert opinion supports the use of prophylactic antibiotics when a trip is vitally important or the consequences of watery diarrhoea would be difficult to manage (for example, after colostomy or ileostomy). Sulfonamides and tetracyclines should not be used because of widespread resistance. A fluoroquinolone is the drug of choice when travelling to most areas of the world, and several randomised trials support its efficacy. 20 Campylobacter spp are often resistant to fluoroquinolones, and when the relative risk is higher, such as in South Asia and South East Asia, azithromycin can be considered. No trials have been published on this agent when used for prophylaxis. Rifaximin, a poorly absorbed derivative of rifamycin, is an alternative choice in regions where E coli predominates, such as Latin America and Africa. 21 Because of decreased efficacy, it should not be used when potentially invasive pathogens such as Salmonella , Campylobacter , and Shigella are likely.

How can travellers’ diarrhoea be treated?

Since behavioural modifications, vaccines, and chemoprophylaxis have limited efficacy on travellers’ diarrhoea or may be associated with adverse events, consensus opinion based on randomised placebo controlled and comparative trials supports self treatment (table 2 ⇓ ). The goals of treatment are to avoid dehydration, reduce the severity and duration of symptoms, and prevent interruption to planned activities.

 Approach to prophylaxis and treatment of travellers’ diarrhoea in adults

Hydration and diet

Hydration is a key intervention that should be done for all forms of diarrhoea and is often all that is necessary in mild illness. Infants and young children, elderly people, and those with chronic debilitating medical conditions can maintain hydration by drinking oral rehydration formulations that combine electrolytes, sugar, and buffer. A randomised trial on healthy adolescents and adults who were taking loperamide for symptomatic treatment of travellers’ diarrhoea, however, showed no additional benefit from specific oral rehydration compared with drinking potable fluids ad libitum. 22 It is a sensible recommendation during recovery from travellers’ diarrhoea to gradually advance the diet from liquids to more complex solids, although this recommendation may not provide additional benefit if the diarrhoea is also being treated with an antibiotic. 23

Symptomatic treatment

The two most common symptomatic treatments for travellers’ diarrhoea are bismuth subsalicylate or an antimotility agent. Symptomatic treatment alone can be considered for mild to moderate diarrhoea. In a randomised placebo controlled trial, bismuth subsalicylate reduced the number of loose stools by about 50% and was helpful in reducing nausea. 24 Bismuth subsalicylate can be recommended for people with mild diarrhoea, but more effective agents are available for those with moderate or severe diarrhoea. Loperamide has become an antimotility agent of choice because of supporting trials in travellers and its favourable adverse event profile. In a randomised comparative trial with bismuth subsalicylate, loperamide was more effective in controlling diarrhoea and cramping and had a more rapid onset of action, usually within the first four hours. 25 Loperamide should not be given to young children, those with diarrhoea and fever (>38.5°C), or when there is gross blood in the stools. Information on probiotics in the treatment of travellers’ diarrhoea is insufficient.

Antibiotic treatment

Many randomised placebo controlled and comparative trials done over the past 25 years have shown the efficacy of antibiotics in the treatment of travellers’ diarrhoea. 26 Most trials indicate that an antibiotic taken as a single dose or for up to three days will improve the condition within 20 to 36 hours. This shortens the duration of diarrhoea by one or two days when compared with controls taking placebo. Adverse events associated with short course therapy are usually mild. The application of this evidence base to clinical practice has differed among clinicians: some advocate prompt self treatment with antibiotics for moderate to severe travellers’ diarrhoea, whereas others urge a more cautious approach to what is usually a self limited illness. Clinicians will need to decide in discussion with the traveller they are advising, the most appropriate approach, taking into account the traveller’s ability and willingness to tolerate a diarrhoeal illness during his or her trip.

Fluoroquinolones are effective for travellers’ diarrhoea acquired in most areas of the world, except when potentially resistant Campylobacter is common, such as in South Asia and South East Asia. 27 A growing body of evidence documents the effectiveness of azithromycin in treating fluoroquinolone resistant Campylobacter , 28 as well as other enterics. 27 Azithromycin can also be used in the treatment of pregnant women and young children with travellers’ diarrhoea; however, the empirical antibiotic treatment of young children should only be used after careful consideration. Rifaximin was not inferior to a fluoroquinolone in a randomised, double blind trial of treatment in Mexico and Jamaica 29 where E coli associated travellers’ diarrhoea was common, but rifaximin is less effective and not recommended when invasive agents, such as Campylobacter and Shigella , are causative. 30

Combination treatment

Combining an antibiotic with loperamide should be considered for people with classic travellers’ diarrhoea who need prompt resolution of symptoms. Six randomised controlled trials examined combination treatment (single dose or short course antibiotics plus loperamide) compared with an antibiotic or loperamide alone. 31 32 The weight of evidence favoured combination treatment when the predominate organisms were sensitive to the antibiotic. 31 32

How should returned travellers with diarrhoea be evaluated?

Diarrhoea is one of the most common syndromes in travellers who return ill. In a US cohort of returned travellers, diarrhoea affected 13%, 2 and in a large multicentre study (travel clinics and tropical disease units) acute or chronic diarrhoea was diagnosed at a rate of 335 cases per 1000 ill returned travellers. 33 Regions associated with the highest relative rates of gastrointestinal infection, as determined by numbers of clinical visits in returned travellers, were South Asia, South America, and sub-Saharan Africa. 1

Travellers’ diarrhoea can be evaluated in a general practice setting with referral to a specialist as needed. If fever, tenesmus, or gross blood in the stool are not present (that is, non-inflammatory diarrhoea) patients can be treated symptomatically and observed. If the patient seems unwell and there are additional symptoms, however, a stool should be cultured for enteropathogens and empirical antibiotic treatment considered using a fluoroquinolone or azithromycin. Unusually, C difficile associated disease presents after antibiotic treatment for travellers’ diarrhoea. 34 In travellers with diarrhoea that has lasted for 10 days to two weeks or longer, stool samples should be evaluated for Giardia , Cryptosporidium , and other parasites.

Tips for non-specialists

Discuss the likelihood of travellers’ diarrhoea with someone who is planning to travel and advise about avoidance measures to decrease the risk of illness: safe foods, beverages, and eating establishments

Avoidance measures are not always sufficient in preventing travellers’ diarrhoea, therefore review self management options, including when to use symptomatic measures or take antibiotics, and when to seek medical care

Consider referring travellers who have special health needs (for example, HIV infection, immunocompromised, pregnant) to a specialist travel clinic for advice

Send a stool sample for microscopy and culture in returned travellers who are febrile and have complicated diarrhoea; empirical antibiotic treatment can be considered while awaiting the results of stool cultures

Treat afebrile patients who do not have tenesmus or gross blood in the stool symptomatically and observe. Give empirical antibiotic therapy—a fluoroquinolone or azithromycin—to patients who do present with such symptoms, after obtaining a stool sample

Questions for future research

What is the cause of travellers’ diarrhoea when a pathogen cannot be identified?

Do avoidance measures prevent illness?

How often do vero cytotoxin or shiga toxin producing E coli and C difficile associated disease occur in patients with travellers’ diarrhoea?

What is the frequency of irritable bowel syndrome after an episode of travellers’ diarrhoea, and what are the predisposing factors?

What is the role of rifaximin in the prevention and treatment of travellers’ diarrhoea?

How should vaccines be used in the prevention of travellers’ diarrhoea?

Additional educational resources

Ericsson CD, DuPont HL, Steffen, R, eds. Travelers’ diarrhea . 2nd ed. Hamilton, Ontario: BC Decker, 2008—reviews all aspects of travellers’ diarrhoea

World Health Organization. International Travel and Health 2008 ( www.who.int/ith/en/index.html )—authoritative guidance on travel medicine

Centers for Disease Control and Prevention. Health Information for International Travel 2008 ( wwwn.cdc.gov/travel/default.aspx )—authoritative guidance on travel medicine

Al-Abri SS, Beeching NJ, Nye FJ. Traveller’s diarrhoea. Lancet Infect Dis 2005;5:349-60

Diemert DJ. Prevention and self-treatment of traveler’s diarrhea. Clin Microbiol Rev 2006;19:583-94

Cite this as: BMJ 2008;337:a1746

Contributors: DRH planned the paper, wrote the first draft, and is the guarantor. ETR contributed to the content, helped to revise the paper, and agreed to the final submission.

Competing interests: None declared.

Provenance and peer review: commissioned; externally peer reviewed.

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St. Philaret of Moscow: Daily Prayer and Prayer of the Prisoner

St. Philaret of Moscow

St. Philaret left a voluminous inheritance of what can be truly called patristic works. He also composed prayers, 1 one of which has become a part of many people’s morning prayers . It is a prayer not for what we want, but for what God wills—that He would always be before us, working in us His Holy will. 2

Morning Prayer of Metropolitan Philaret of Moscow

O Lord, I do not know what to ask of Thee. Thou alone knowest what I need. Thou lovest me more than I know how to love myself. O Father, grant Thy servant what I myself do not know how to ask. I do not dare to ask a cross of Thee, nor consolation; I only stand before Thee with my heart open; Thou seest the needs that I myself do not know. Look, and work in me according to Thy mercy; smite and heal me, cast me down and raise me up! I am reverent and silent before Thy holy will and ways that are unfathomable to me. I offer myself as a sacrifice to Thee; teach me to pray. Do Thou Thyself pray in me. Amen.

Another prayer attributed to the illustrious hierarch was written for prisoners , who although they have been incarcerated for crimes committed, especially need help from the Lord to bear the difficulty of their penitentiary life. But aren’t we are all seemingly prisoners of circumstances that surround us—family troubles, job loss or difficulty, rocky relationships, poverty, and any other thing that makes us feel like there is no way out? But we can pray to God with these words, that He would give us comfort and the strength to endure everything for the sake of cleansing our own sins, which have most likely brought us to these situations.

Prayer of the Prisoner

O my Lord God and Savior, blessed be Thy holy name!

Thanksgiving and praise be to Thee O Lord, for all the blessings I have received from Thee in this life. Sorrow and sickness have overtaken me, and I call upon Thy name. Reproach has fallen upon me. Thou hast laid me in the pit of hades, in the darkness and house of the dead. I sorrow for this, and I understand that I have this sorrow because I have sinned before Thee, and for my sins have these afflictions come upon me. For Thy righteous ones were not downcast, and even in prisons called out to Thee, and rejoiced in sufferings.

For if Thous shouldst mark iniquities, O Lord, O Lord, who shall stand? For there is no man that hath not sinned. But Thou, O Lord, dost bear the sins of the world and cleansest through repentance. I believe, for thou hast not turned even me, a sinner, away from Thy Face. Thy Only Begotten Son didst pour out His blood for the whole world. I believe that He can cleanse even me from my sins, and desires this.

Therefore with David I say: I will confess mine iniquities before the Lord against myself. And Thou forgavest the ungodliness of my heart. I fear the judge and judgment of man, but even more do I fear Thy irrevocable judgment and eternal condemnation. For unrighteousness has risen up against me; I make bold to pray to Thee with David’s words: Hearken O Lord unto my righteousness, and hear my judgment, and deliver me by Thy righteousness.

For although I have committed unrighteousness, heal my unrighteousness by Thy mercy. Do not allow my heart to incline to deceitful words, to hiding the truth, and false justification. Help me to understand and to hate my unrighteousness, to love righteousness, and in truth surround my soul with comfort. Ease the burden of my afflictions. Endure also me, the condemned, that I may endure with patience for the sake of cleansing my sins and for the sake of Thy merciful, righteous judgment.

For if shame has covered me before certain people, may I endure it with humility; may I receive They mercy, O Lord, and may I not be put to shame before the face of the world at Thy Dread [Last] Judgment.

I come to Thee woeful and sorrowful; deprive me not of Thy spiritual consolation. I come to Thee darkened; show me the light of hope for salvation. I fall down before Thee in exhaustion; raise me up and confirm me in Thy grace.

And above all grant me the desire and help me, O Lord, in everything to do Thy will; that in peace I may glorify Thy holy name, of the Father, and the Son, and the Holy Spirit. Amen.

1   The translations of these prayers given in this post are our own (not official).

2   When searching in Google for the “Prayer of St. Philaret of Moscow”, one seems always to find not this prayer, but the prayer of the Optina Elders: “O Lord, grant me to greet the coming day in peace, help me in all things to rely upon Your holy will. In every hour of the day reveal Your will to me. Bless my dealings with all who surround me. Teach me to treat all that comes to me throughout the day with peace of soul and with firm conviction that Your will governs all. In all my words and deeds, guide my thoughts and feelings. In unforeseen events, let me not forget that all are sent by You. Teach me to act firmly and wisely, without embittering and embarrasssing others. Give me strength to bear the fatigue of the coming day with all that it shall bring. Direct my will, teach me to pray. And, Yourself, pray in me. Amen.” These prayers are very similar.

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MOSCOW – TRAVEL IN RUSSIA

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More travelers using Pullman-Moscow Regional Airport

PULLMAN – Federal officials say passenger boardings increased about 21.5 percent at the Pullman-Moscow Regional Airport between 2015 and 2016.

The Moscow-Pullman Daily News reported that the information is contained in a Federal Aviation Administration report presented Friday to the airport board.

About 62,000 passengers boarded flights in 2016, up from about 51,000 in 2015.

The Lewiston-Nez Perce County Airport saw an increase of 9.2 percent during the same time.

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Moscow Sheremetyevo International Airport

Travel Guide Europe Russia Moscow Moscow Sheremetyevo International Airport

Introduction

Moscow Sheremetyevo International Airport (SVO) is located almost 30 kilometres from Moscow and is one of the city's 3 airports, along with Domodedovo International Airport (DME) and Vnukovo (VKO).

For more information about other airports throughout the world, also see the list of airports .

Getting there and away

• Car : The main road leading to the airport is Leningradskoe Highway which can get jam-packed with cars during the rush hour, so start out early. It takes from 20 minutes to several hours!
• Taxi : about US$30-40, widely available
• Minivans ( marshrutkas ) and shuttles have fixed prices and are basically shared taxis
• Buses are much slower, but there are a few lines connecting to the metro network
• Rail : In 2008, a rail terminal opened in front of Terminal F with direct service from Savyolovsky Rail Terminal. The journeys takes 35 minutes. In 2009 the line was continued to Belorussky Rail Terminal, future plans include a new central rail terminal which will service all three of Moscow's main airports. The rail link is operated by Aeroexpress, a subsidiary of Russian Railways.

Getting around

A shuttle bus service takes passengers from Terminal F (railway station) to the other terminals.

Airlines, Destinations and Terminals

There are 5 terminals (B to F) at the airport. For more information, also see the list of airlines or the details about flying with budget airlines .

• Avianova - Astrakhan, Archangelsk, Gelendzhik, Kazan, Krasnodar, Nizhnekamsk, Perm, Rostov-on-Don, St.Petersburg, Samara, Sochi, Ufa, Ulyanovsk, Yekaterinburg
• Belavia - Minsk
• Ural Airlines - Yekaterinburg
• Aerosvit Airlines - Dnipropetrovsk, Donetsk, Kiev-Boryspil, Odessa, Simferopol
• Air Algérie - Algiers
• Ariana Afghan Airlines - Kabul
• Armavia - Yerevan
• Aeroflot - Antalya, Astrakhan, Athens, Baku, Barcelona, Barnaul, Berlin-Schonefeld, Brussels, Cairo, Dresden, Dubai, Düsseldorf, Eilat-Ovda, Frankfurt, Gelendzik, Geneva, Hamburg, Hanoi, Hanover, Havana, Heraklion, Irkutsk, Istanbul-Ataturk, Kaliningrad, Kemerovo, Khabarovsk, Krasnodar, Krasnoyarsk, Larnaca, London-Heathrow, Madrid, Magadan, Malaga, Milan-Malpensa, Munich, Nizhnevartovsk, Norilsk, Novosibirsk, Omsk, Oslo-Gardermoen, Paris-Charles de Gaulle, Perm, Petropavlovsk-Kamchatsky, Riga, Rome-Fiumicino, St Petersburg, Samara, Simferopol, Sochi, Split, Tel Aviv, Tokyo-Narita, Tyumen, Ufa, Ulan Bator, Venice-Marco Polo, Vladivostok, Volgograd, Yekaterinburg, Yuzhno-Sakhalinsk, Zagreb, Zürich
• Aeroflot operated by Donavia - Mineralnye Vody, Neryungri, Novosibirsk, Rostov-on-Don, Surgut, Ufa, Volgograd
• Aeroflot operated by Nordavia - Anapa, Arkhangelsk, Astrakhan, Chelyabinsk, Krasnodar, Murmansk, Naryan-Mar, Omsk, Syktyvkar, Yekaterinburg
• Delta Air Lines - Atlanta, New York-JFK
• Nordavia - Simferopol
• Rossiya - St Petersburg
• Air Astana - Almaty, Astana
• Air France - Paris-Charles de Gaulle
• Estonian Air - Tallinn
• KLM - Amsterdam
• Adria Airways - Ljubljana
• Aeroflot - Amsterdam, Bangkok-Suvarnabhumi, Beijing-Capital, Beirut, Belgrade, Bishkek, Bucharest-Henri Coanda, Budapest, Copenhagen, Damascus, Delhi, Helsinki, Hong Kong, Hurghada, Innsbruck, Karlovy Vary, Kiev-Boryspil, Los Angeles, Luanda, New York-JFK, Nice, Prague, Salzburg, Seoul-Incheon, Shanghai-Pudong, Sharm-el-Sheikh, Sofia, Stockholm-Arlanda, Tashkent, Tehran-Imam Khomeini, Vienna, Warsaw, Washington-Dulles, Yerevan
• airBaltic - Riga
• Air China - Beijing-Capital
• Air Koryo - Pyongyang
• Air Malta - Malta
• Alitalia - Milan-Malpensa, Rome-Fiumicino, Turin
• Bulgaria Air - Burgas, Sofia, Varna
• China Eastern Airlines - Shanghai-Pudong
• China Southern Airlines - Urumqi
• Cyprus Airways - Larnaca
• Czech Airlines - Karlovy Vary, Prague
• Finnair - Helsinki
• Hainan Airlines - Beijing-Capital
• Hong Kong Airlines - Hong Kong
• Iran Air - Tehran-Imam Khomeini
• Jat Airways - Belgrade
• Korean Air - Seoul-Incheon
• LOT Polish Airlines - Warsaw
• Malév Hungarian Airlines - Budapest
• MIAT Mongolian Airlines - Berlin-Tegel, Ulan Bator
• Royal Air Maroc - Casablanca
• Scandinavian Airlines - Copenhagen, Stockholm-Arlanda
• Transaero Airlines - Antalya, Dalaman, Heraklion, Hurghada, Punta Cana, Sharm el-Sheikh, Tel Aviv
• Turkish Airlines - Antalya, Istanbul-Atatürk, Istanbul-Sabiha Gokcen
• Turkish Airlines operated by Anadolujet - Istanbul-Sabiha Gökçen

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This is version 3. Last edited at 19:30 on Jul 25, 10 by Utrecht . 5 articles link to this page.