Written by: Abier Hamami. RPH.CPHQ
10-12-2005

What is Travelers’ Diarrhea?

Travelers’ Diarrhea is a diarrhea that affects travelers, and usually occurs within the first week of travel but may occur at any time while traveling, and even after returning home.

How do you get traveler's diarrhea?

You usually get this disease by eating foreign foods. You may become infected through the water you drink, the ice cubes you use, the food that is washed by water such as fruits and vegetables, people handling your food, the flies landing on your food, and food that is not adequately cooked.

What causes travelers' diarrhea?

The commonest causative organisms are bacteria, such as E. coli, salmonella, shigella and campylobacter. Parasites or protozoa can also cause travelers' diarrhea but less frequently.

What are the common symptoms of travelers’ diarrhea?

Usually the traveler experiences four to five loose or watery bowel movements each day, and could suffer other symptoms as nausea, vomiting, abdominal cramping, bloating, fever, urgency, and malaise.

What preventive measures you can do to avoid this?

· Avoid eating foods or drinking beverages where unhygienic conditions are present.

· Avoid eating raw or undercooked meat and seafood.

· Avoid eating raw fruits, and vegetables unless you peel them.

· Drink bottled carbonated beverages, or boil the water.

Is prophylaxis of travelers' diarrhea recommended?

Several studies show that bismuth subsalicylate taken as either 2 tablet or 2 fluid ounces 4 times daily reduces the incidence of travelers' diarrhea. The mechanism of action appears to be both antibacterial and antisecretory. Use of bismuth subsalicylate should be avoided by persons who are allergic to aspirin, during pregnancy and by persons taking certain other medications (e.g., anticoagulants, probenecid, or methotrexate). In addition, persons should be informed about potential side effects, in particular about temporary blackening of the tongue and stool, and rarely ringing in the ears. Because of potential adverse side effects, prophylactic bismuth subsalicylate should not be used for more than 3 weeks.

What can you do if you get this disease?

Here are some of the things you can do to help relieve your self of the symptoms.

· Drink safe or treated water to replace the lost fluids and minerals from your body. Or take oral electrolyte solutions like Babylyte or Rehidrat.

· Eat foods rich in gluten and fiber (pasta,lentils, potatoes, rice, etc.), and avoid dairy products.

· Antimotility agents like loperamide or diphenoxylate chlorhydrate should be used with caution, even though they reduce diarrhea by slowing transit time in the gut, and allows more time for absorption, but they also slow the excretion of the infectious agent and can sometimes cause complications (such as toxic megacolon). They are contraindicated in the presence of high fever or blood in the stools.

· Fluoroquinolones Antibiotics ( ciprofloxacin, norfloxacin ) are the current first choice of treatment, and should be used only if the diarrhea is severe, more than 8 episodes in 24 hours.

It is preferable to consult a doctor if there is blood in the stools, or in the presence of persistent fever.

Reference:
Center of Disease Control