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.