Traveler's Diarrhea:

What is it? And What Can you Do About It?

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Traveler's diarrhea (TD) is one of the more common problems encountered when visiting countries with sanitary infrastructure and hygienic norms that are different from those to which we are accustomed. Depending on the destination of the traveler, the incidence of TD is between 30-70%. Although careful attention to food and water consumption is helpful in preventing the acquisition of serious enteric diseases, it is not a panacea for TD. Travelers who follow the rules may still come down with diarrhea, largely because of poss sanitation in restaurants. Therefore, the prepared traveler know how to recognize TD and to manage it themselves. TD is rarely severe enough to warrant a visit to local doctor, but it is also important to be able to distinguish a more serious medical problem.

What Causes Travelers Diarrhea (TD)?

• The symptoms and duration of TD are determined by the germs that cause it. For even the most informed traveler, it is usually impossible to guess which germ is responsible for a bout of diarrhea. However, it is important to distinguish two different types of diarrheal illnesses -- non-inflammatory vs. inflammatory.

Non-inflammatory enteritis:

Inflammatory enteritis:

Causes of Travelers' Diarrhea and Efficacy of Antibiotics

CAUSE

% OF TD CASES

SPECIFIC AGENTS OF ENTERITIS

RESPONDS TO ANTIBIOTICS?

Bacterial

80-90%

Non-inflammatory: E. coli, Campylobacter, Salmonella

yes

 

 

Inflammatory: Campylobacter, Shigella, Salmonella

yes

Viral

5-10%

Non-inflammatory: norovirus, rotavirus, other

no

Parasitic

10%

Non-inflammatory: Giardia, Cryptosporidium

no

Diarrhea and vomiting may also occur as a result of "food poisoning." Although the term "food poisoning" may mean different things to different people, in this context, it refers to brief illnesses that occur because of contamination of foods with either microbial or other toxins. "Food poisoning" is therefore not an infection and typically resolves in ~12 hours. Since it is not an infection, antibiotics are of no benefit. It is not known what proportion of TD is due to food poisoning, but the assumption is that this food-borne illness is relatively rare and usually associated with outbreaks rather than individual illnesses.

Self-Management of Traveler's Diarrhea

If you have visited a travel clinic in preparation for your trip, you were probably given a prescription for an appropriate antibiotic and advice concerning the self-treatment of TD. Here are a few points to remember:

• Do not use the antibiotic for any reason other than TD.

• Do not take the antibiotic to prevent TD. Although this practice may rarely be justified in special circumstances, this practice may actually increase the risk of acquiring other enteric infections.

• Begin taking the antibiotic as prescribed after developing:

• If you have non-inflammatory enteritis, you may use loperamide (Imodium) to control the diarrhea immediately. If you have any signs of inflammatory enteritis (e.g., fever, bloody stools, severe abdominal pain), do not take loperamide.

• Maintain your hydration. You will feel better if you do not become dehydrated. Symptomatic dehydration is not common in adults but may occur in children.

Note: Inflammatory enteritis that persist for more than a few days in spite of antibiotic therapy should warrant a visit to a local physican. High fever and chills could be signs of illnesses other than TD and may require different kinds of treatment.

Antibiotics That Our Clinic Prescribes for Self-Treatment of TD

Non-Prescription Medications for Travelers' Diarrhea

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