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Traveler's Diarrhea

Traveler's diarrhea is the most common infectious disease experienced by international travelers. It can be caused by bacteria (most common), viruses or parasites that have been ingested through contaminated food or drink. Traveler's diarrhea can be mild to extreme in severity.

Preventing traveler's diarrhea

Remember: boil it, cook it, peel it, or forget it! In other words, if you don't boil, cook, or peel your food, you could get sick.

Other prevention tips include:

  • Wash your hands with soap and water or use alcohol-based hand sanitizers before eating.
  • If you're having coffee, tea, or other drinks that require water for preparation, use bottled or disinfected water.
  • Don't use tap water for drinking or brushing your teeth, and be sure to avoid ice. Drink bottled water with an intact seal or purify water yourself.bottled water.jpg
  • Avoid unpasteurized dairy products.
  • Avoid food of questionable preparation or origin (like buffets).
  • Avoid food from street vendors.
  • Steer clear of food that has been rewarmed (like quiche).
  • To clean vegetables, start with boiled water, and add bleach (2-4 drops per liter of water). You may also use enough iodine tablets to make the water the color of dark tea. Soak veggies in the water for several hours, and then drain produce and rinse again with clean water.

Treating traveler's diarrhea

Traveler's diarrhea can range from mild to severe. Treatment varies based on severity.

Mild diarrhea

Mild traveler's diarrhea is characterized by 3-4 unformed stools in 24 hours with mild cramping.

intestines.jpgRecommended treatment:

  • Drink plenty of clear fluids or consider the use of Oral Rehydration Solution (ORS) or Ceralyte. (Appropriate for adults and children.)
  • Loperamine (Imodium AD) will decrease diarrhea for about 4 hours, allowing you to travel or sleep. Follow the directions on the box of loperamine. Not to be used for children under 12 or if you have bloody diarrhea.
  • Try to eat as soon as possible. It's best to start with easily digested foods, like bananas, rice, applesauce and toast. Avoid milk products for 72 hours after last diarrhea.

Moderate diarrhea

Symptoms of moderate traveler's diarrhea include increased frequency of unformed bowel movements with one or more of the following: Fever up to 101° F, abdominal pain, nausea or vomiting.

Recommended treatment:

  • Drink plenty of clear fluids or consider the use of Oral Rehydration Solution (ORS) or Ceralyte. (Appropriate for adults and children.)
  • Loperamine (Imodium AD) will decrease diarrhea for about 4 hours, allowing you to travel or sleep. Follow the directions on the box of loperamine. Not to be used for children under 12 or if you have bloody diarrhea.
  • Prior to your trip, an antibiotic will be prescribed for you depending on your history and destination. It is important to discuss all your medications with your provider before taking antibiotics, as some drugs reduce the efficacy of antibiotics, or cause unpleasant side effects:
    • Ciprofloxacin (Cipro), which should be taken in conjunction with Loperamine (Imodium AD). Not to be used in pregnant or breastfeeding women, or in children under 18.
    • Azithromycin (Zithromax), the preferred medication for children under 18. It may be dispensed as a powder to allow a parent or guardian to administer it as a liquid. Azithromycin should be taken with food to avoid stomach upset.
    • Rifaximin (Xifaxan), which is used for individuals who are not able to tolerate other antibiotics.

Severe diarrhea

Severe traveler's diarrhea is moderate diarrhea with or without abdominal cramping/pain, fever, blood in stool, dehydration. You can take antibiotics if you have severe diarrhea, but if symptoms worsen seek medical care. These symptoms could indicate a more severe infection, such as giardia or amoebiasis.

Diarrhea in children

Young children (under age 5) are particularly susceptible to becoming dehydrated from diarrhea. Do not use loperamine (Imodium AD) in children.

If a breastfeeding infant has diarrhea, continue breastfeeding. An infant or toddler should have at least one wet diaper every 4-6 hours. If there is a longer period between wet diapers, the child needs more fluids and should be seen by a health care provider. Parents and guardians should have a low threshold for seeking medical help if a child in their care experiences vomiting and diarrhea.

Additional resources

 

Authored by: Hall Health Center Travel Clinic staff

Reviewed by: Hall Health Center Travel Clinic staff, May 2014