Traveler's diarrhea

Diarrhea continues to be the most frequent medical complaint of travelers. A change of water, food or climate can all cause the runs. When traveling in any underdeveloped country, drinking the water, and eating food that is kept and prepared in less than ideal conditions can expose you to the risk of intestinal bacterial infection.

Traveler's diarrhea is characterized by two-fold or greater bowel movements and may be accompanied by abdominal cramps, nausea, and bloating. Infectious pathogens transmitted through fecally contaminated food and / or water are responsible for the vast majority of traveler's diarrhea.

Mild to moderate diarrhea

Despite all precautions, you may still have a mild bout of travelers' diarrhea. Moderate diarrhea is defined as two to six loose bowel movements in a day. The symptoms can occur any time from several hours to as much as a couple of days after the exposure to tainted food or water.

Dehydration is the main danger with any diarrhea. Dehydration can occur quite quickly in children. Fluid replacement remains the mainstay of management. Replace lost body fluids by drinking plenty of pure water from sealed bottles. Weak black tea with a little sugar is also good. Another remedy is to drink cooled water that has been used to boil rice. It is likely that the affect is similar to that of taking Imodium due to the starch contained within the water. Never drink alcohol or soft-drinks (soda) while suffering from diarrhea.

Lomotil or Imodium can be used to bring relief for mild to moderate symptoms, although they do not actually cure the problem. Only use these drugs if absolutely necessary -- if you must travel. Imodium is preferable for children, but under all circumstances fluid replacement is the most important thing to remember. Do not use Lomotil or Imodium if the person has a high fever or is severely dehydrated.

Severe diarrhea

Symptoms of more severe diarrhea may include an abrupt onset of painful abdominal cramps, nausea, vomiting, and diarrhea which may contain blood.

With severe diarrhea, it is especially important to replace lost body salts with electrolyte replacement products such as rehydrating solutions. Commercially available ORS (oral rehydration salts) are very useful -- add the contents of one sachet to a liter of boiled or bottled water. In an emergency you can make up a solution of eight teaspoons of sugar to a liter of boiled water and provide salted cracker biscuits at the same time. You should stick to a bland diet as you recover. If the condition does not respond to treatment within 24 hours, a doctor should be consulted.

In certain situations antibiotics may be indicated:

1 - Watery diarrhea with blood and mucous (gut-paralyzing drugs like Imodium or Lomotil should be avoided in this situation)

2 - Watery diarrhea with fever and lethargy

3 - Persistent diarrhea for more than five days

4 - Severe diarrhea, if it is logistically difficult to stay in one place

The recommended drugs (for adults only) would be either norfloxacin 400mg twice daily for three days or ciprofloxacin 500mg twice daily for three days. The drug of choice for children would be co-trimoxazole (Bactrim, Septrin, Resprim), with dosage dependent on weight. A three-day course is given. Ampicillin has been recommended in the past and may still be an alternative.

Prevention of traveler's diarrhea

When traveling to developing countries, one's likelihood of getting TD can be severely reduced by adhering to a few drinking and eating precautions. Most importantly, assume that water is unsafe to drink unless you know otherwise. Even in upscale hotels, a cautionary mind-set is recommended.

To minimize the chance of suffering a case of diarrhea, drink water that has been boiled such as tea and coffee. (Boiling water for five minutes (longer at high altitude) will make it safe to drink.) Alternately, water can be chemically treated with iodine or chlorine. Potable water filters, while convenient, are not a proven method of purification and are not currently recommended. Pure water from sealed bottles, or canned and bottled beverages such as carbonated soda, beer, or wine is fine. Unbottled drinks and fruit juices, and unpasteurized milk are likely to be heavily contaminated and should be avoided. Avoid ice if you cannot be sure the water was boiled or purified before it was frozen.

Eat only cooked foods. Salads and raw vegetables that have been washed in the local water can be harmful. Peeled fruits, milk products not properly refrigerated, and poorly cooked meat, poultry, fish, and shellfish should be avoided as well. Where the food is prepared is equally important. And although the outward appearance of a restaurant doesn't tell you about the cooks' hygienic practices, established restaurants are generally safer than street vendors.

Do not believe that eating expensive meals in large hotel restaurants will be safer than eating in stalls and markets. The places that are used by the local population are often likely to be among the safest to eat at.

Taking bismuth subsalicylate (the active ingredient in Pepto-Bismol) prior to travel has been found to decrease the likelihood of getting TD. The side effects of such prophylactic use, however, are poorly understood and the list of people who should not take bismuth subsalicylate (e.g., those with renal insufficiency) is long. The Centers for Disease Control (CDC) therefore recommends against taking bismuth subsalicylate to prevent TD for periods of more than three weeks.

Certain antibiotics (e.g., ciprofloxacin) taken prior to travel have also been found to lower the risk of TD. However, antibiotics are only effective against certain (i.e., bacterial) infectious agents and many travelers should not receive such antibiotics; therefore, the CDC does not recommend the wide spread use of antibiotics to prevent TD.

No vaccine is currently available for traveler's diarrhea.

Diseases