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Diseases & Conditions

Travelers Diarrhea

Traveler's diarrhea is a stomach and intestinal infection that occurs because of unsanitary handling of food. Food handlers who do not wash their hands after they use the bathroom can transmit the infection to people who consume the contaminated food.

Areas with the highest risk of contracting traveler’s diarrhea include the developing countries of Africa, the Middle East, and Latin America. The risk of infection varies depending on the type of eating establishment visited -- from fairly low risk in private homes to high risk in food from street vendors.

The most common culprit is a bacteria called E. coli.

What are the symptoms of traveler’s diarrhea?

The typical symptoms of traveler’s diarrhea include:

  • Abrupt onset of diarrhea
  • Nausea and vomiting
  • Bloating
  • Urgent need to have a bowel movement
  • Malaise (weakness or discomfort)
  • Explosive and painful gas
  • Cramps
  • Loss of appetite

Traveler’s diarrhea usually lasts from 3 to 7 days and is very rarely life threatening.

How do I treat traveler’s diarrhea?

As with all diseases, it is best to consult a doctor rather than attempting to self-medicate, especially if you are pregnant or if the afflicted person is a child.

Preventive

Pepto-Bismol (2 ounces four times daily, or two tablets four times daily) taken before and during international travel can help prevent many cases of diarrhea. Pepto-Bismol should not be taken for longer than 3 weeks. When taken for treatment, Pepto-Bismol decreases diarrhea frequency and shortens the duration of the illness.

Side effects of Pepto-Bismol can include temporary blackening of tongue and stools, occasional nausea and constipation, and rarely, ringing in the ears. Do not take Pepto-Bismol if you have an aspirin allergy, renal insufficiency, gout, or if you are taking anticoagulants, probenecid (Benemid, Probalan), or methotrexate (Rheumatrex).

Treatment

The treatment of traveler's diarrhea requires the replacement of fluids and salts lost from the diarrhea. This is best achieved by use of an oral rehydration solution, such as the World Health Organization’s oral rehydration salts (ORS) solution. ORS packets are available at stores or pharmacies in almost all developing countries. ORS is prepared by adding one packet to boiled or treated water. Packet instructions should be followed carefully to ensure that the salts are added to the correct volume of water. ORS solution should be consumed or discarded within 12 hours if stored at room temperature, or within 24 hours if it is refrigerated.

An over-the-counter antidiarrheal medication, such as Lomotil or Imodium, can decrease the number of diarrheal stools but can cause complications for people with serious infections. These drugs should not be used by anyone with a high fever or blood in their stools.

Antibiotics (which require a prescription) such as doxycycline (Vibramycin), trimethoprim/ sulfamethoxazole (Bactrim, Septra) and ciprofloxacin (Cipro) or norfloxacin (Noroxin) may shorten the length of illness. The CDC does not recommend the use of antibiotics to prevent traveler’s diarrhea because they can sometimes cause additional problems. Consult your doctor about taking these medications.

Special population: Children

It is important to consult a doctor about treating diarrhea in children and infants because some of the drugs mentioned above are not recommended for children. The greatest risk for children, especially infants, is dehydration. The best treatment for dehydration is the ORS solution.

Breastfed infants should continue nursing on demand. For bottle-fed infants, full-strength lactose-free or lactose-reduced formulas should be used. Be sure to mix the formula with boiled water. Older children receiving semisolid or solid foods should continue to receive usual foods if they have diarrhea. Immediate medical attention is required if an infant or child with diarrhea develops signs of moderate-to-severe dehydration (including dry mouth, eyes and skin; confusion; sunken eyes; and fever), bloody diarrhea, persistent vomiting, or fever higher than 102º Fahrenheit.

When should I call the doctor?

Seek medical help if:

  • Diarrhea is severe, bloody, or does not resolve within a few days
  • It is accompanied by fever and chills
  • Fluids consumed are not able to be retained (dehydration becomes a concern).

How can I protect myself from traveler's diarrhea?

In areas with poor sanitation, only the following beverages may be safe to drink: boiled water, hot beverages (such as coffee or tea) made with boiled water, canned or bottled carbonated beverages, beer, and wine. Ice may be made from contaminated water and should be avoided.

It is safer to drink from an unopened can or bottle than from a container that is not known to be clean and dry. Water on the surface of a beverage can or bottle may also be contaminated. Therefore, the area of a can or bottle that will touch the mouth should be wiped clean and dried. Where water may be contaminated, you should not brush your teeth with tap water.

How can I make water safe to drink?

Boiling is the most reliable method to make water safe to drink. Bring water to a vigorous boil, then allow it to cool; do not add ice. At high altitudes, allow water to boil vigorously for a few minutes or use chemical disinfectants. Chemical disinfection can be achieved with either iodine or chlorine. Iodine usually provides greater disinfection. For disinfection with iodine, use either tincture of iodine or tetraglycine hydroperiodide tablets, such as Globaline or Potable-Aqua. These disinfectants can be found in sporting goods stores and pharmacies. Read and follow the manufacturer's instructions. If the water is cloudy, strain it through a clean cloth and double the number of disinfectant tablets added. If the water is very cold, either warm it or allow increased time for the disinfectant to work. Adding a pinch of salt or pouring water from one container to another will improve the taste.

Portable water filters are not recommended due to lack of independently verified results of the filters' effectiveness.

As a last resort, if no source of safe drinking water is available, tap water that is uncomfortably hot to touch may be safer than cold tap water. However, many disease-causing organisms can survive the usual temperature reached by the hot water in overseas hotels, and boiling or proper disinfection is still advised.

What precautions should I take with food?

Food should be selected with care. Foods you should avoid include:

  • Salads
  • Uncooked vegetables and fruit. If you peel fruit yourself, it is generally safe.
  • Unpasteurized milk and dairy products
  • Raw meat and shellfish

Food that has been cooked and is still hot is usually safe. Some fish is not guaranteed to be safe, even when cooked, because of the presence of toxins in its flesh. Tropical reef fish, red snapper, amberjack, grouper, and sea bass can occasionally be toxic at unpredictable times if they are caught on tropical reefs rather than in the open ocean. The barracuda and puffer fish are often toxic and should generally not be eaten. Seafood from the islands of the West Indies and the tropical Pacific and Indian Oceans should be avoided, as it is more likely to contain toxins.

References:

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 3/12/2012...#7315