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Prevention and Treatment of Traveler’s Diarrhea

Traveler's Diarrhea is type of diarrhea that results from eating or drinking water contaminated with feces while traveling in other countries. Up to half of all Americans who visit the tropics pick up traveler’s diarrhea (or “Montezuma’s revenge”) or, in Spanish-speaking countries, “turista.”

Areas of high risk include the developing countries of Africa, the Middle East, and Latin America.Traveler’s diarrhea is more common in younger people. The risk of infection varies depending on where the child eats, from a low risk (in private homes) to high risk (food from street vendors).

Cause

Most traveler’s diarrhea is caused by a special strain of the common intestinal bacteria ESCHERICHIA COLI.Other bacteria responsible for SALMONELLA POISONING and SHIGELLOSIS can also cause diarrhea, as can the parasitic conditions of GIARDIASIS and amebiasis.

Symptoms

Diarrhea, nausea, bloating, urgency, and malaise that usually lasts from between three to seven
days. Even if traveler’s diarrhea is not treated, it will go away by itself in most cases. Diarrhea that
lasts more than four days or is accompanied by severe cramps, bloody stools, dehydration, or foulsmelling
gas should be reported to a physician.

Treatment

Drink plenty of fluids to replace water; add oral rehydration packets to fluids to replace lost minerals.
Several prescription and over-the-counter drugs will relieve symptoms or kill bacteria. One of the best treatments for early diarrhea is the antibiotic combination trimethoprim/sulfamethoxazole (Bactrim), which is 90 percent effective against the organisms that cause traveler’s diarrhea. Bactrim can usually shorten the illness and ease the symptoms.

The most widely used antidiarrheal medication is the over-the-counter drug Pepto-Bismol (bismuth subsalicylate), which treats the symptoms instead of killing the bacteria. Pepto-Bismol appears to be effective in preventing traveler’s diarrhea (two ounces four times a day, or two tablets four times a day), but this is not recommended for more than three weeks at a time. Side effects of this preventive treatment include temporary blackening of the tongue and stools, occasional nausea and constipation, and rarely, ringing in the ears.

Pepto-Bismol should be avoided by those allergic to aspirin or who have kidney problems, seizures,
or gout. Parents should discuss this preventive treatment with a doctor before giving it to children
or teens.

Scientists at West Virginia University have discovered that wine is capable of killing bacteria that
cause diarrhea much faster than did Pepto-Bismol, tap water, tequila, or pure alcohol. In the case of
salmonella, for example, the wines destroyed about 10 million bacteria in just 20 minutes; it took the
Pepto-Bismol two hours to reach the same effect.

Prevention

Since most diarrhea-causing organisms are waterborne, they can be passed on in untreated water or
on food handled by people who have not properly washed their hands. Before leaving for a trip, a
physician can provide a prescription to take along for antidiarrheal medicine. In order to prevent this
type of diarrhea while traveling, children and their parents should avoid:

• drinking tap water or using it to brush teeth (even in good hotels)
• ice in sodas or alcoholic drinks
• mixing alcohol with water
• milk or dairy products unless they have been pasteurized Instead, travelers should:
• boil water for tooth brushing for five minutes, or add water purification tablets
• avoid bottled water unless it is carbonated (the carbonation process inhibits bacterial growth)
• drink carbonated beverages, beer, wine, coffee, or tea
• wipe off bottle or can tops before drinking
• not eat raw vegetables, fruits, meat, or seafood
• avoid cold buffets left in the sun for several hours
• avoid garden or potato salads or food from street vendors
• eat only hot cooked meals, fruit with peels, and packaged foods