Traveler’s Diarrhea

Traveler’s Diarrhea
Michael N. Peters, M.D., FACG/mfr

Congratulations. The time for your big trip has finally arrived. If your travel will take you to a developing nation in Central or South America, the Middle East, Asia or Africa, you are aware that certain precautions are needed so that diarrhea will not spoil your trip or worse, seriously threaten the health of your child or spouse. How can Traveler’s Diarrhea be avoided? Also, if the worst happens despite precautions, what can be done to treat it?

Acute diarrheal illness is common among travelers, affecting up to half of visitors to developing countries. Germs are the most common cause, followed by viruses and, rarely, parasites. Most often, the source of fecally contaminated drink or food. All water, even for tooth brushing, must be boiled or chemically treated (iodine or chlorine) or taken from a sealed commercial bottle that you open. All cans or bottles should be wiped clean and dried. Carbonated beverages (no ice!), coffee or boiled tea and wine or beer are safe. All dairy products must be pasteurized. Only eat well-cooked foods (no raw shellfish!) and fruit you peel yourself. No salads or other uncooked vegetables are allowed and never consume street vendor food. The old aphorism is “Boil it, peel it, cook it or forget it.”

If you are more susceptible to such infections or their effects because of underlying illness, very young or advanced age, the use of medications that reduce stomach acid, inflammatory bowel disease or celiac sprue, your doctor may advise the use of prophylactic antibiotics. Currently, the standard medical advice for most people is to use antibiotics only if symptoms develop; but a new antibiotic, Rifaximin, is being tested for efficacy and safety as prophylaxis against bacterial diarrhea for most travelers to developing countries. Most individuals should take prescription antibiotics on the trip just in case. The choice of medication depends upon the time of year, the area visited, and individual factors. Consult your doctor at least six weeks before travel; you may also need vaccinations.

Despite all your precautions, you may wake up several days after beginning your vacation (or even shortly after returning home) with aches, nausea and vomiting, cramps and diarrhea. The most important part of treatment is to maintain hydration.

Water is sufficient for most adults, but infants and children and elderly or infirm persons should be given oral rehydration salts in boiled or treated water. The salt specimen is specific by the World Health Organization and packets are widely available overseas at stores and pharmacies. Continue to eat because it helps maintain or restore intestinal tissue. The antibacterial supplied by your doctor should be started promptly, but if serious symptoms such as high fever, intense pain, or bloody diarrhea develop, seek local medical care. Anti-diarrheals such as loperamide (Imodium) may decreased cramping and the number of stools but will not abbreviate the illness and should be avoided with the “serious symptoms” mentioned above. The probiotics that have been tested were not effective and Pepto-Bismol was only moderately helpful.

For additional information, such as specific risks in a particular country, consult the CDC at http://www.CpC.gov/travel. Remember, travel abroad is often a source of unforgettable and unique experiences. These few precautions will make the trip more safe and enjoyable for all.