Traveler’s Diarrhea
Traveler’s diarrhea (TD) is caused by bacteria, protozoa, or viruses from contaminated food or beverages. Eating contaminated food causes most illnesses. These do not affect local residents because they have built up immunity over time. Most TD is bacterial and has an abrupt onset. To help prevent TD in areas with poor sanitation, follow these basic guidelines:
- Wash your hands frequently, especially before touching your face or eating.
- Assume that canned, bottled, boiled, or carbonated liquids are the only safe drinks.
- Do not accept beverages where the seal has been broken; refilling bottles may be more common in developing countries.
- Don’t brush your teeth with—or drink—tap water.
- Avoid ice cubes.
- Any fruits or vegetables that you wash and peel with clean hands are safe. Avoid leafy or raw vegetables and salads.
- Baked goods, dry food, and canned foods are safe.
- Avoid unpasteurized dairy products such as cheese, yogurt, or milk.
- Choose piping hot, thoroughly cooked food.
- Avoid cold sauces and toppings, open buffets, and undercooked or incompletely reheated foods.
Drink plenty of fluids during your trip to avoid general dehydration.
Treatment
If you get TD, stay hydrated by focusing on fluid replacement as the main treatment. Include salt-containing foods in the diet to replenish electrolytes. Drink plenty of low-sugar fluids while avoiding caffeine, milk, alcohol, and fat.
Bismuth subsalicylate
Bismuth subsalicylate, in Pepto-Bismol, can reduce diarrhea symptoms or help prevent diarrhea. Taking 2 tablets 4 times a day can reduce the likelihood of getting TD by 65 percent. (If taking for prevention, do not take for more than three weeks.)
Treatment of mild TD consists of taking 2 chewable tablets every 30 minutes for 8 doses—a total of 16 tablets.
Possible side effects include black stool or tongue, nausea, or constipation. Do not take bismuth subsalicylate if you are taking aspirin, other subsalicylates, anticoagulants, probenecid, methotrexate, or doxycycline.
Loperamide hydrochloride
Loperamide hydrochloride (Imodium) slows intestinal movement and can control diarrhea. Available without a prescription, loperamide hydrochloride does not cure diarrhea. Take according to the label directions, not to exceed 48 hours.
Antibiotics
Your health care provider may prescribe antibiotics for you to use for self-treatment if you get severe diarrhea. Antibiotics can reduce the average length of TD from several days to about one day. Start antibiotics if three or more watery stools occur in a day or if there is fever or bloody diarrhea associated with the watery stools. A combination of loperamide and an antibiotic can rapidly improve TD.
Directions for use of ciprofloxacin: (adults only)
Take 750 mg in a single dose with loperamide If not totally well after one dose, complete the three-day course of
ciprofloxacin taking 750 mg once daily. If symptoms do not improve within 48 hours or worsen despite use of antibiotics,
seek medical help.
Directions for use of azithromycin: (adults only)
Take 500 mg in a single dose with loperamide. When high fever (39.4 C or 102F) or if passing bloody stools, take 1000 mg
of azithromycin in a single dose. If not totally well after one dose, seek medical help.
Directions for use of rifaximin: (adults only)
Take 200 mg three times daily for three days. Travelers with high fever (39.4 C or 102F) and/or bloody diarrhea will not be
effectively treated if prescribed this medication and should seek medical care.
Notify your health care provider if diarrhea persists after returning home.
