Who Is at Risk to Get Traveler’s Diarrhea?
Travelers are at risk of diarrhea, when they move from a high hygiene area to low hygiene areas. For western travelers, high risk areas are: Africa, South Asia, Central and South America, Caribbean and the Pacific islands.
Prevention of Traveler’s Diarrhea
1. Vaccination, Medications
Before a travel, children should be vaccinated against rotavirus. Information about common infections in planned destinations should be obtained. Preventive taking of antibiotics in general is not recommended because of their possible side effects, but if someone needs to be protected as much as possible, antibiotics, prescribed by a doctor, may be started 2-3 days before a travel; this prevents diarrhea in most cases.
Bismuth subsalicylate (Pepto-Bismol) reduces intestinal secretion and has a slight antimicrobial effect, but avoidance of risky foods is still the main measure to prevent diarrhea (1). Its use should be limited to 3 weeks; children under the age of 3 and pregnant women should not take it. Pepto-Bismol may color the tongue and stool black.
2. Washing Hands
- Wash hands with soap after using the toilet, before a meal and before sleeping.
- Do not touch the lips or pick teeth with fingers and use disposable tissues to blow the nose or clean the face.
Safe and Unsafe Foods
SAFE drinks and food during the travel: bottled water, bottled carbonated drinks, alcohol beverages, hot tea, canned food, fruits that can be peeled by the user, cooked foods which are served hot. Boiling disinfects water in less than a minute; food should be cooked as long as necessary (meat should not stay red in the middle). Chemical disinfection of water with chlorine is effective in the time provided on the product label (some minutes). Disinfection with iodine does not kill a parasite cryptosporidium. Filtering with special filters holds bacteria and parasites but not viruses, so additional chemical disinfection is needed. NOTE: Packaged foods by themselves are not safe because they are packaged; they should also be pasteurized.
NOT SAFE: tap water (not even for washing food or teeth), ice cubs made from tap water, unpasteurized sweets, fruit juices or milk (even if bottled), any raw, non-packed food bought on the open market (meat, vegetables).
Medications in Traveler’s Diarrhea
In most cases, traveler’s diarrhea is caused by bacteria, it starts suddenly, lasts for 2-3 days and heals on its own, so antibiotics are not needed. In heavy or prolonged diarrhea, adults may take norfloxacin or ciprofloxacin; children and pregnant women should take azithromycin. These antibiotics are effective against most bacteria which cause traveler’s diarrhea, so stool tests are usually not required. In bloody diarrhea, a stool test should be done to identify the causing microorganism, though. Bismuth subsalicylate (Pepto Bismol) alone may sometimes shorten the course of bacterial diarrhea.
Parasites giardia, entamoeba, cryptosporidium and cyclospora usually cause mild diarrhea, which may last up to a month or longer, though. Antibiotic metronidazole is recommended for parasites (mild, prolonged, relapsing course of diarrhea is a sufficient sign for self-diagnosis of parasite infection). A combination of antibiotic Rifaximin and loperamide brought immediate relief of diarrhea to some American students in a study conducted in the Gulf of Mexico in 2005 (2).
A person with diarrhea should drink enough safe (bottled or boiled) water or tea to prevent dehydration and eat as much as he/she feels comfortable.
Sometimes diarrhea may appear weeks or months after the end of the travel, like in infection with shigella or parasites, or in tropical sprue. Travelers who repeatedly visit the same country, may gradually develop some (not complete) immunity against particular microorganisms, so, with time, they may have less problems with diarrhea. Some travelers may develop post-infectious IBS (irritable bowel syndrome) , months after their travel.
- Diarrhea After Eating
- Bacterial Diarrhea in Food Poisoning
- Human Intestinal Parasites and Diarrhea
- Human Intestinal Worms – Pictures, Treatment
- Causes of Acute Diarrhea
- BSS – Pepto Bismol (cptips.com)
- Rifaximin plus loperamide effective in traveler’s diarrhea (docguide.com)
Article reviewed by Dr. Greg. Last updated on December 1, 2009