People from the industrialized countries often
suffer from diarrhea while traveling to countries like Latin America, Southern
Asia and Africa. Traveler's diarrhea, as
the condition is referred to, is most commonly caused by the E. coli bacteria
Other implicated bacteria include Campylobacter jejuni, Shigella and Salmonella
species. Viruses like rotavirus and
norovirus and parasites like Giardia and Cryptosporidium can also cause
Traveler's diarrhea is more common in some regions
of the world. The regions where people run at a high risk of traveler's
diarrhea include the Middle East, Latin America, Southern Asia, Mexico, and
Africa. Intermediate-risk regions include Eastern Europe, South Africa, and
parts of the Caribbean Islands, whereas areas of low risk are United States,
Canada, Australia, New Zealand, Japan, and Western Europe.
The risk for contacting traveler's diarrhea depends
not only on the region visited but also on the traveler. For example, people suffering from low immunity, inflammatory bowel
disease or diabetes are more prone to develop traveler's diarrhea. Excess
alcohol consumption may also be a predisposing factor.
diarrhea usually spreads through contaminated food and water. Thus, a judicious choice
of food could help to reduce the chances of contacting the infection. Foods
that should preferably be avoided are raw foods, moist foods served at room
temperature or unpasteurized dairy products. On the other hand, safer foods
include hot, freshly cooked and dry foods, fruits that can be pealed, food that
is self washed and prepared, or food with high sugar content. Bottled sealed
water from reputed brands or carbonated drinks are usually safe.
Symptoms of traveler's diarrhea are usually limited
to the digestive tract with passage of 3 or more loose stools in 24 hours,
abdominal pain, nausea, loss of appetite, vomiting and bloody stools.
Traveler's diarrhea may be accompanied by a low-grade fever. Symptoms usually
last for 3 to 5 days.
If symptoms last for more than 14 days, the
condition is called persistent traveler's diarrhea.
How does one prevent traveler's diarrhea? The best way is to be aware of the
condition, and this is possible through appropriate patient education. One
simple advice given to travelers regarding food is "Boil it, cook it, peel it, or forget it." However, not all
travelers manage to adhere to all the eating recommendations in a new place.
contacting traveler's diarrhea are also reduced by repeated hand washing with
soap and water, especially while cooking, before eating and after using the
toilet. A hand sanitizer with at least 60% alcohol may be used if soap is not
Bismuth subsalicylate can prevent traveler's
diarrhea when taken for up to 3 weeks, but it does have side effects and cannot
be used in all patients. Similarly, antibiotics to prevent traveler's diarrhea
are not routinely recommended due to chances of side effects and the
possibility of development of antibiotic resistance. They may be considered in
some cases like in people with reduced immunity, chronic intestinal conditions,
or those on a very important trip who cannot afford to fall sick, like a
business trip or an important athletics meet. In these cases, ciprofloxacin
with rifamixin is usually advised.
Travelers are usually advised to carry necessary
medication and start taking them in case of diarrhea. Since traveler's diarrhea
can result in massive fluid and electrolyte loss and dehydration, it is
important to maintain adequate hydration during the attacks.
Antibiotics are used for
moderate-to-severe cases that do not respond to symptomatic treatment. Fluoroquinolones like
ciprofloxacin and levofloxacin may be given for 3 days. Azithromycin or
rifamixin may be useful in some cases.
Drugs that reduce motility like loperamide may be
given along with the antibiotic especially while travelling. They should
however be avoided in complicated cases associated with fever or bloody stools.
traveler's diarrhea may be prevented by taking adequate precautions while
eating and drinking in a foreign place. Treatment with rehydration and
sometimes antibiotics helps to control the condition.
1. Approach to Treatment and Prevention of Traveler's Diarrhea; Sean
Nguyen et al; US Pharmacist 2011