Notes from a Doctor's Practice

Even I wasn't immune to this. Traveler's diarrhea is the most common illness for people traveling to less developed regions of the world. So how can the traveler manage a diarrheal episode without ruining their trip or their health?

More than 90 percent of diarrheal illness in travelers is caused by bacteria with E Coli being the most common culprit. What are your chances of getting traveler's diarrhea? Well less than 10 percent in Northern Europe, Singapore and Japan, between 10 and 20 percent in the Caribbean, South Africa and Israel. Your chances are greater than 30 percent in Asia, Africa, South and Central America and Mexico.

Let's start by repeating what many of us already know. Lettuce, fruit salads or chicken salads are unwise food choices but fruits that have just been peeled are safe. Freezing does not kill the organisms so ice drinks are not safe unless made from adequately boiled or filtered water (and no, alcohol does not sterilize the ice). Condiments on the table can frequently become contaminated and guacamole and pico de gallo in Mexico are known for high colony counts of bacteria.

What will you feel like if you get nailed with traveler's diarrhea? Most episodes happen between 4 and 14 days after arrival. You can have a mild form with just soft stools 1-2 times a day or moderate illness with more frequent diarrhea and at least one other symptom: nausea, vomiting, abdominal pain and cramps, fever and bloody diarrhea. The illness is self-limited and usually lasts 1-5 days but this duration can be shortened with early antibiotic use.

Approach the diarrheal illness in this way: slow it down, replace your fluids and think about starting antibiotics. Fluid replacement is essential with mild diarrhea and you can alternate sips of fluids with both salt and sugar to replete and maintain hydration. Broth, fruit juice, or similar fluids may be used. Severe diarrhea should be treated with oral rehydration solution and packets of ORT can be found in the pharmacies of most countries and can be mixed with clean drinking water. Anti-motility agents (Imodium or lomotil) may be required if you are having 3-5 bowel movements a day and may help limit symptoms for a period of hours and allow you to get some things done. Antibiotics shorten the duration of illness to about one day and should be started in anyone with bloody diarrhea. If you do have antibiotics you should start them right at the onset of the illness to shorten its course.

So you will bring with you on your trip: Imodium, an antibiotic and the addition of an anti-nausea medication like compazine suppositories isn't a bad idea. Antibiotic choice is up to your physician but a common regimen is ciprofloxacin 500 mg twice a day for 3 days or Levaquin 500 mg daily for 3 days and for women you get the added plus that this is the first choice regimen for urinary tract infections which may also try and spoil your vacation. You can manage traveler's diarrhea on your own in most cases but if you get no relief of your symptoms 10-14 days later you should see your doctor.

How should you eat once you start feeling better? Start eating only when you start to feel an interest in food. Bland foods like bread, rice, bananas, and applesauce are good to start with if you can get your hands on them yet dairy products and high fat foods will just run right out of you after an illness like this.

Hang in there, this too shall pass.

Dr O.