Traveler's Diarrhea

Traveler’s Diarrhea

One of the most common concerns of international travelers is how to prevent "traveler's diarrhea" and how to manage the illness if they are stricken with this problem in a foreign country. Traveler's diarrhea usually refers to an acute illness with sudden onset of watery diarrhea, cramps, nausea and general malaise. The disease occurs when travelers visit areas of the world where sanitation is a problem and is usually contracted through ingestion of contaminated food or water. The watery diarrhea and other symptoms commonly associated with traveler's diarrhea can be uncomfortable, but the disease will usually resolve without specific treatment in 4-6 days. However, for travelers with a busy itinerary this may be too long a time to be confined to a hotel room. It also makes traveling by public transportation inconvenient. For most patients, symptomatic treatment of traveler's diarrhea is appropriate, and self-treatment with an antibiotic may be appropriate if reliable medical help is not readily available. Our clinic does not endorse the use of prophylactic antibiotics for the prevention of diarrhea.

CAUTION: Any illness that is characterized by high fever (greater than 102 degrees), severe abdominal pain, or the passage of grossly bloody stools is serious, and medical help should be sought as soon as possible.

PREVENTION: Select safe food and water while traveling. Eat foods thoroughly cooked, no salads or raw seafood. Avoid milk, ice cream, yogurt and unpasturized dairy products. Drink bottled carbonated beverages or beverages such as tea and coffee that have been prepared with boiling water, Avoid ice cubes in cold drinks and use boiled or chemically purified water when in doubt about tap water. Use safe water to brush teeth and to take medication.

Bismuth subsalicylate (PEPTO-BISMOL) 30-60 ml (1 -2 oz.) of Pepto Bismol liquid 4 times a day has been found to be useful in the prevention of diarrhea. However, this may be inconvenient as the higher dose is equal to a bottle for each day of a journey. 2 Pepto Bismol tablets taken 3-4 times a day have been useful in the prevention of diarrhea. Note: High doses of bismuth may cause stools and/or tongue to turn black, but it will not harm you. TREATMENT OF SYMPTOMS: dehydration due to loss of body fluids from diarrhea can accentuate the general feeling of misery. Travelers having 5 or more watery bowel movements a day need to pay special attention to oral rehydration with safe liquids such as the W.H.O. Oral Rehydration Formula, Gastrolyte, Pedialyte, E.R.G., canned juices, Gatorade, or soups. Relief of cramps and frequency of bowel movements using LIQUID PEPTO-BISMOL: take 4 tablespoons orally every 30 minutes until relieved or until an 8 ounce bottle is finished. Do not take more than this in 24 hours. Relief is generally obtained within one day. The Pepto Bismol regimen is not recommended for children, people allergic to salicylates, or people on aspirin therapy. In addition, eating a bland diet may provide some relief. Foods such as steamed rice, bananas, clear liquids and soups may help. It is best to avoid fried or fatty foods when diarrhea is present as these foods may make diarrhea worse.

Relief of cramps and frequency of bowel movements using drugs: Use of antiperistaltic agents (drugs that slow the normal contractions of the gastrointestinal tract) are contraindicated in gastrointestinal disturbances like bacterial dysentery and amoebiasis as they may make the illness more severe. However, there is no evidence that these medications are harmful when used to relieve the symptoms of uncomplicated traveler's diarrhea. Thus, antiperistaitic agents, such as Imodium, may be used by a traveler stricken with watery diarrhea and cramps if he or she does not have a high fever (greater than 102) and if the bowel movements are not grossly bloody.

CAUTION: If using an antiperistaltic drug, one still needs to pay attention to increasing oral rehydration during a diarrheal illness. The body is still losing fluids from the tissues into the intestines, even if these fluids are not being passed as frequently into the toilet because the antiperistaltic drug has been taken.

ANTIBIOTIC TREATMENT OF TRAVELER'S DIARRHEA: Several antibiotic regimens appear to be useful in the treatment of traveler's diarrhea. Travelers are advised to try symptomatic treatment of diarrhea as discussed above, and to consider antibiotics if they feel they are not getting significant relief using symptomatic treatment alone, or if bloody diarrhea or a high fever is present and medical help is unavailable.

Levofloxacin 250 mg tablet: 2 tablets on day one, then one per day for two more days if diarrhea persists.

Trimethoprim/Sulfamethoxazole Double Strength tablets (Septra DS or Bactrim DS): One tablet by mouth twice a day for 5 days.

Ciprofloxacin (Cipro) 500 mg tablet: one tablet by mouth twice a day for 3-5 days.

Patients who need special counseling are women of child-bearing age (as the above medications cannot generally be taken during pregnancy), children, patients with histories of allergies to drugs, and patients with underlying chronic medical conditions, especially patients with gastrointestinal diagnoses.

GIARDIA: Glardia Lamblia is a microscopic singlecelled parasite that is present all over the world. Infections are usually acquired through contaminated water or food. Symptoms of a giardia infection include frequent watery bowel movements, increased gas and bloating, upper abdominal discomfort, decreased appetite and fatigue. Symptoms may be intermittent. Treatment of giardia involves medications that may have serious side effects. Metronidazole (Flagyl) is frequently used in the United States (one 500 mg tablet by mouth 3 times a day for 7 days). Tinidazole (Fasigyn, Tineba) is frequently used in foreign countries (four 500 mg tablets by mouth as a single dose). You should seek medical consultation before using either medication. If using these medications, consumption of alcoholic beverages must be avoided because of unpleasant side effects.

Revised 1/2000 Travel Medicine Service

University of Washington Medical Center

1959 NE Pacific Box 356123

Seattle, WA 96195

(206) 598-4888