Managing Traveler's Diarrhea

Traveler’s diarrhea is commonly caused by bacterial contamination of food and water. Adequate hydration and sometimes antibiotics are used to treat traveler’s diarrhea.

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.

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.

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Scientists have identified the structure of bacteria responsible for traveler's diarrhea.

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.

Traveler’s 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.

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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.

Rifaximin

This medication is an antibiotic, prescribed for traveler's diarrhea caused by certain bacteria and liver disease affecting the brain (hepatic encephalopathy). It prevents the growth of bacteria inside the intestine (gut).

Chances of 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 available.

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.

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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.

Thus, 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.

Reference:

1. Approach to Treatment and Prevention of Traveler’s Diarrhea; Sean Nguyen et al; US Pharmacist 2011

Source-Medindia