Health Topic: Travel Medicine

by Dr. Wilbur Kuo, MD
March 19, 2016


Today's topic: Travelers' diarrhea

- Most common illness for travelers
- Affects >20% of travelers to South and Southeast Asia, Africa (with the exception of South Africa), South and Central America, and Mexico
- 10-20% of travelers to Caribbean Islands, South Africa, Central and East Asia (including Russia and China), Eastern Europe, and the Middle East, including Israel
- <10% of travelers to Northern and Western Europe, Australia and New Zealand, the United States, Canada, Singapore, Japan

Symptoms
- water diarrhea
- malaise
- abdominal cramping
- nausea
- vomiting
- lasts 1-5 days

Prevention
- only eat food that has been throughly cooked and served hot
- peel fruit just before eating
- make sure dairy products are pasteurized
- drink bottled beverages from the bottle with a straw
- drink without ice; freezing does not kill the organisms that cause diarrhea
- be aware that alcohol does not sterilize water or ice
- carbonated beverages are generally safe

Ways to purify water
- boil 3 minutes and then cool to room temperature
- add two drops of 5% bleach to a quart of water and wait 30 minutes
- add 5 drops of tincture of iodine to a quart of water and wait 30 minutes
- compact water filters are available at camping stores

Treatment
- fluid replacement
* broth, fruit juice, pedialyte, gatorade
* in severe cases, can use oral rehydration solution. can pick up packet in pharmacy or mix 1/2 tsp salt, 1/2 tsp baking soda, 4 Tbsp sugar to 1 Liter of water
- bland diet: rice, toast, clear liquids
- antibiotics
* usually ciprofloxacin 2x/day for 3 days; can consider azithromycin single dose in Asia or for pregnant women
* used for severe diarrhea: more than 4 diarrhea/day; fever; blood; pus; mucous in stool
- anti-diarrheal agents
* bismuth subsalicylate
* imodium
* prescription lomotil
* avoid if having fever or bloody stool
- symptoms lasting more than 10 days needs further evaluation

Before your trip
- Consult your physician about whether bringing a prescription for antibiotics or antidiarrheals would be appropriate
- Consider whether your trip needs include water purification methods or oral rehydration solution packets

As always, consult your physician before diagnosing yourself or starting any new treatment!

For more information, check out wwwnc.cdc.gov/travel or
Massachusetts General Hospital gten.travel/trhip/trhip