Robin considered herself a seasoned traveler. She'd been south of the border before, so when she visited a friend in Mexico City, she knew better than to drink the water. But she let her guard down at a dance club in Acapulco and had a drink "on the rocks." She spent the next seven hours on a bus battling Montezuma's Revenge. "The discomfort was excruciating," says the 30-something writer from Arkansas.
Traveler's diarrhea is the most common illness affecting travelers. Bacterial infections (in many cases a strain of E. coli) cause most cases of traveler's diarrhea (TD), but viruses and parasites may also be culprits. Travelers who ingest contaminated food or drink may experience a range of symptoms—including urgency, watery diarrhea, nausea, vomiting, fever, and abdominal pain—that typically last for 3-7 days.
Visitors to developing countries, most notably in Latin America, the Middle East, Asia, and Africa, put themselves at increased risk of TD, according to the United States Centers for Disease Control and Prevention (CDC). TD goes hand in hand with poor sanitation and poor refrigeration, says David N. Taylor, MD, director of the division of communicable diseases and immunology at the Walter Reed Army Institute of Research. He advises travelers to use common sense when determining where and what to eat while abroad. For example, five-star hotels that cater to foreigners are generally safer bets than open-air markets.
"If you're going to be eating with locals on the corners in Bangkok, then you're at high-risk," says Dr. Taylor, who experienced his worst bout of TD after enjoying a street festival in Peru.
For travelers who don't want to limit their destinations, a healthy dose of awareness can lower their risk of TD. Here are some tips when visiting high-risk locations:
It's a good idea to see your doctor to get medicines before you go. Dr. Taylor prescribes travelers a supply of antibiotics (typically ciprofloxacin, or Cipro ) and advises them to take along antidiarrheal medicine (such as Imodium ).
Dr. Taylor recommends that, at the first sign of diarrhea, travelers begin a two- to three-day course of antibiotics and take antidiarrheals medications as needed for more immediate relief. "You don't get any gold stars for holding off on treatment," he says.
He cautions against giving antidiarrheal medicine to young children. Young children with diarrhea should see a doctor early on, because they are at higher risk for dehydration than adults. For mild to moderate diarrhea in children, keep the child well-dehydrated with clean water or an electrolyte replacement product such as Pedialyte. If the child's diarrhea is severe (10 or more watery stools per day) or the child is urinating less frequently (a sign of dehydration) seek medical care immediately.
The Infectious Disease Society of America (IDSA) has made recommendations to prevent TD. Some recommendations include:
If you have a trip planned, talk to your doctor about these and other recommendations.
When TD strikes, travelers who want to salvage valuable trip time need to do more than just take medicine. Staying well-hydrated by drinking plenty of safe fluids is also essential. While this is true for everyone, it is especially important for pregnant women and children, in whom dehydration can have a more immediate and debilitating effect. Dehydrated travelers can also find relief using oral rehydration salts (ORS), widely available in developing countries. However, ORS should not be used as a substitute for clean, plentiful water.
Seek immediate medical care for TD in any of the following situations:
In some cases, TD can persist despite antibiotic treatment. Rarely, it can trigger other gastrointestinal problems. See your doctor if symptoms do not resolve after you return home.
RESOURCES:
The International Society of Travel Medicine
http://www.istm.org
National Center for Infectious Diseases: Travelers' Health, United States Centers for Disease Control and Prevention
http://www.cdc.gov/travel
CANADIAN RESOURCES:
Communicable Disease Control Unit (Manitoba Health, Public Health Branch)
http://www.gov.mb.ca/health/publichealth/cdc/index.html
Travel Medicine Program, Public Health Agency of Canada
http://www.phac-aspc.gc.ca/tmp-pmv/index.html
References:
Discharge instructions for traveler's diarrhea. EBSCO Patient Education Reference Center website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=16&topicID=1034. Updated September 30, 2009. Accessed December 16, 2009.
Traveler's diarrhea. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated November 30, 2009. Accessed December 16, 2009.
Traveler's diarrhea. EBSCO Health Library website. Available at: http://www.ebscohost.com/thisTopic.php?marketID=15&topicID=81. Updated December 2, 2009. Accessed December 16, 2009.
Traveler's diarrhea. United States Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/travel. Updated November 21, 2006. Accessed December 16, 2009.
Last reviewed December 2009 by Brian Randall, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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