August 1, 2015
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Travel Medicine (cont.)

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Traveler's diarrhea

Traveler's diarrhea is the most common medical complaint in travelers, occurring in up to 50% of travelers to developing countries. It occurs when infectious organisms are inadvertently ingested by travelers, resulting in one to five days of loose stools. The stools are often watery and may be accompanied by abdominal cramps. Although not fatal, traveler's diarrhea can cause dehydration, vomiting, low-grade fever, and discomfort to the point that some travelers have to change their itineraries. It is important to note that traveler's diarrhea is not associated with bloody stools, severe abdominal pain, or high fever. These symptoms are suggestive of more serious conditions and should prompt medical attention.

Traveler's diarrhea is spread when bacteria or other infectious agents such as viruses are ingested. Traveler's diarrhea is most often spread through contaminated food or water, or by putting contaminated hands in the mouth. Even small amounts of contamination can cause infection. Although bacteria are the most common cause of traveler's diarrhea, there have been outbreaks of diarrhea on cruise ships caused by noroviruses. Noroviruses are very small (only visible on ultrathin-section electron microscopy) and spread readily from person to person.

Travelers can get diarrhea in most areas of the world, but some countries pose a higher risk. High-risk areas include most of Asia, the Middle East, Africa, and Central and South America. Risk is increased if the traveler is adventurous with his or her diet, eats foods from street vendors, or travelers to areas off the usual tourist routes.

Protective measures may help prevent or shorten the duration of traveler's diarrhea. All travelers should wash their hands often and understand basic food and water precautions (see below). However, it has been shown that even well-informed travelers often choose to eat foods that pose an increased risk of traveler's diarrhea. Therefore, travelers at risk should carry along an antimotility agent such as loperamide (Imodium; Kaopectate II; Imodium A-D; Maalox Anti-Diarrheal Caplets; Pepto Diarrhea Cont) and start taking it if they get symptoms. Bismuth subsalicylate (Pepto-Bismol) is also helpful.

Many physicians also recommend that travelers carry along an antibiotic to take in case they get diarrhea. Fluoroquinolones are the most commonly prescribed antibiotic; azithromycin (Zithromax, Zmax) or rifaximin (Xifaxan) are alternatives. Because bacteria are developing resistance to many antibiotics, many of the older antibiotics do not work well. If an antimotility agent (a drug that reduces gastrointestinal motility) and an antibiotic are started at the first sign of diarrhea, symptoms may be shortened to only a few hours instead of a few days. In rare cases, physicians might prescribe daily antibiotics or daily bismuth subsalicylate to prevent diarrhea, but this is not needed for most travelers. Affected people should stay hydrated. Pregnant women and children need special advice because many of these drugs are not appropriate for them.

Medically Reviewed by a Doctor on 4/30/2014

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