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Traveler’s Diarrhea

By Jeffrey Sterling, MD March 25, 2019

Introduction

This Straight No Chaser discusses traveler’s diarrhea.

traveler's diarrhea emergency

This is the time of year in the U.S. when you wished you were somewhere else. (Hawaii, Africa, Australia or Mexico for a nice cruise, anyone?) Unfortunately, sometimes when you travel, you get more than you hoped.

Traveler’s Diarrhea

“Montezuma’s Revenge” is often the punchline of a joke in the U.S. However, traveler’s diarrhea (TD) is a serious concern. It is the most common illness contracted by travelers, affecting approximately 10 million people per year. Individuals visiting the U.S. can suffer from it as well. Although we tend to forget that fact, it provides a clue as to what’s actually occurring with TD.

Traveler’s diarrhea is typically a response to an infection by a strain of bacteria known as E. coli. Specifically, a toxin in E. coli affects the intestines. This is the case approximately 80% of the time. Parasites sometimes figure prominently in the illness. The risk and primary source of this infection is food or water that is contaminated with feces. Note that most any disturbance in the bacterial balance of the intestines can cause disruptions in the digestive system, leading to diarrhea.

travelers-diarrhea-risk-map

Risks for Traveler’s Diarrhea

Anyone can contract traveler’s diarrhea. However, destinations and personal characteristics can markedly increase that risk.

  • Higher risk destinations include developing countries in Africa, Asia, Latin America and the Middle East.
  • Those individuals at higher risk include the immunocompromised, diabetics, young adults and those with inflammatory bowel disease. Also, those taking antacids or medicines known as H-2 blockers are at increased risk.

Symptoms and Tips

TD is straightforward. Symptoms include watery diarrhea and cramps. A mild fever may or may not be present.

So, what are you supposed to do to prevent TD? This stuff is miserable! Here are a few tips and pointers for you:

  • Avoid street vendors.
  • Trying to not eat (or minimize eating) raw or undercooked foods (especially meats and seafood).
  • Avoid raw fruits and vegetables (unless you peel them).
  • Wash your hands!
  • Taking antibiotics in advance (prophylactically) is not recommended. Unfortunately, they can increase your susceptibility to resistant organisms and side effects.
  • Bismuth subsalicylate (two ounces or two tablespoons four times daily) reduces the incidence of TD. Speak to your physician or SMA expert consultant about the risks and indications of taking bismuth subsalicylate. By the way, you know bismuth subsalicylate as pepto-bismol or kaopectate.

Treatment

And now, a few words about treatment. Here are a few considerations about which you should be aware.

  • TD is usually mild and will run its course without medication. In other words, you’re likely to be just fine.
  • The most important consideration is to ensure adequate hydration. Clear fluids are key.
  • You may need antibiotics if symptoms progress to include fever, bloody stools, nausea, vomiting and severe cramps. Drugs typically include ciprofloxacin and norfloxacin. Previously used drugs such as trimethoprim-sulfamethoxazole and doxycycline aren’t recommended anymore. Unfortunately, these drugs have a high resistance rate.
  • In addition to its role in prevention, bismuth subsalicylate may also be used as treatment.
  • A  special word about anti-motility (anti-diarrhea) medications: There are some benefits to using these agents, but there are also significant risks. You should not take these medications without understanding the risks and how they may affect you based on your existing health profile.

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