For as long as there have been travelers, there has been travelers’ diarrhea. Diarrhea, dysentery and enteric fever, the triad of gastrointestinal infectious diseases, have determined the outcome of wars, have shortened the lives of poets and artists seeking inspiration on foreign shores, and have been the subject of literature.
Traveler’s Diarrhea is the most common complain when traveling abroad. Over 50 million travelers from the industrialized nations visit tropical and developing areas of the world each year. A quarter to more than half of these international travelers are afflicted with diarrhea during their trips abroad, making this illness the most common travel-related health problem. It also can occur shortly after the traveler gets home.
Traveler’s Diarrhea occurs from bowel microbial contamination of ingested food or/and water. It results most commonly in persons traveling from an area of more highly developed sanitation infrastructure to a less developed one. There is a considerable diversity in causing agents, which include bacteria, parasites, or viruses, being Escherichia coli, a bacterium, the most common cause.
You probably have traveler's diarrhea if you have at least three loose stools in 24 hours. You also will have one or more of the following symptoms: fever, vomiting, stomach cramps, or bloody stools. You also can have a milder case with sudden watery diarrhea and stomach cramps. About 10% of cases may last up to 2 weeks. Travelers’ diarrhea is, for the most part, a mild, self-limited illness; however, even a day of relative incapacitation can disrupt a carefully planned vacation.
What to do?
1. Care in selecting food and beverages for consumption may minimize the risk for acquiring TD. Eat foods that are freshly cooked and served piping hot and to avoid water and beverages diluted with water (reconstituted fruit juices, ice, milk) and foods washed in water, such as salads. BOIL IT, PEEL IT OR FORGET IT!!!
2. Prophylaxis: For travelers to third world countries, with special conditions like:
a) AIDS/HIV or Immunocompromise (e.g. Transplant recipient).
b) Insulin-dependent DIABETES MELLITUS.
c) INFLAMMATORY BOWEL DISEASE.
d) A History of stomach surgery or if you are taking medication that reduces stomach acid (e.g. achloridia, or in reflux, heartburn or ulcers).
e) Essential business or activities that cannot be compromised by illness (E.G. Special diplomatic missions, elite sport person)
f) Heart disease and taking diuretics.
g) Psychiatric problem taking LITHIUM.
It is recommended taking ANTIMICROBIAL PROPHYLAXIS like PEPTO BISMOL 2 tablets or 60ml four times a day for this purpose or RIFAXIMIN 200mg (Flonorm™) three times a day, one non-absorbable antibiotic…not minimizing care with food and beverages!
3. Keep Hydrated / Oral Rehydration Therapy
Fluid and electrolytes are lost in cases of diarrhea, and replenishment is important, especially in young children or adults with chronic medical illness. In adult travelers who are otherwise healthy, severe dehydration resulting from traveler Diarrhea is unusual unless vomiting is present. Nonetheless, replacement of fluid losses remains an important adjunct to other therapy. Travelers should remember to use only beverages that are sealed or carbonated. For more severe fluid loss, replacement is best accomplished with oral rehydration solutions (ORS), such as World Health Organization ORS solutions, which are widely available at stores and pharmacies in most developing countries.
4. CIPRO XR 1 gram of slow release Ciprofloxacin, daily, for stand-by treatment, 1-2 days. (Particularly if you are away from medical assistance) reduces severity of diarrhoea (number of days and bowel movements). (For Trips to South East Asian countries including China, Vietnam, Malaysia, Thailand, Laos and Indonesia, we use AZITHROMYCIN instead of Ciprofloxacin because of antibiotic resistance).
5. Loperamide 1mg. (Imodium®) second line medication, which offers you symptomatic relieve. Reduces bowel movement frequency and enables you to resume your activities. Take one tablet after the first loose stool, followed by one tablet after each subsequent loose stool (maximum of 4-5 mg in 24 hours for two days) (caution in case of high fever or bloody diarrhoea, no for children)
6. Should any of the following signs and/or symptoms develop, medical care should be sought immediately:
-- Vomiting of blood, black bowel movements, blood or mucous in the bowel movement,
-- Signs of dehydration (dizziness, weakness, dry skin, sunken eyes, parched lips, deep yellow urine, reduction of tears and urine).
-- If diarrhoea does not resolve within 3 days.
-- If high fever (>101°F, 38°C) continues after 1 day of beginning antibiotics.
-- If you have persistent diarrhoea after returning home.
More information:
a) Health Protection Scotland, National Health Services.
Travellers’ Diarrhoea
http://www.fitfortravel.nhs.uk/
General/Travellers_Diarrhoea.html,
b) American Academy of Family Physician. Information from your family Doctor.
Traveller’s Diarrhoea: What you should know: http://www.aafp.org/
afp/20050601/2107ph.html
