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Description: Traveler's diarrhea: don't let it ruin your vacation

Robin considered herself a seasoned traveler. She'd been south of the border before, so when she visited a friend in Mexico City, she knew better than to drink the water. But she let her guard down at a dance club in Acapulco and had a drink 'on the rocks.' She spent the next seven hours on a bus battling Montezuma's Revenge. 'The discomfort was excruciating,' says the 30-something writer from Arkansas.

A common problem for travelers Every year, roughly half of travelers to developing countries experience some type of traveler's diarrhea (TD), making it the most common travel-related illness, says Colonel David N. Taylor, MD, director of the division of communicable diseases... More

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Traveler's diarrhea: don't let it ruin your vacation

Robin considered herself a seasoned traveler. She'd been south of the border before, so when she visited a friend in Mexico City, she knew better than to drink the water. But she let her guard down at a dance club in Acapulco and had a drink 'on the rocks.' She spent the next seven hours on a bus battling Montezuma's Revenge. 'The discomfort was excruciating,' says the 30-something writer from Arkansas.

A common problem for travelers Every year, roughly half of travelers to developing countries experience some type of traveler's diarrhea (TD), making it the most common travel-related illness, says Colonel David N. Taylor, MD, director of the division of communicable diseases and immunology at the Walter Reed Army Institute of Research. Although it is rarely life-threatening, TD can be a quite a 'pain in the rear.'

Bacterial infections (in many cases a strain of E. coli) cause most cases of TD, but viruses and parasites may also be culprits. In up to 20% of cases, however, a specific cause is never identified. Travelers who ingest contaminated food or drink may experience a range of symptoms—including urgency, watery diarrhea, nausea, vomiting, fever and abdominal pain—that typically last for three to seven days.

Location, location, location Visitors to developing countries, most notably in Latin America, the Middle East, Asia and Africa, put themselves at increased risk of TD, according to the U.S. Centers for Disease Control and Prevention (CDC).

TD goes hand in hand with poor sanitation and poor refrigeration, Dr. Taylor explains. He advises travelers to use common sense when determining where and what to eat while abroad. For example, five-star hotels that cater to foreigners are generally safer bets than open-air markets.

'If you're going to be eating with locals on the corners in Bangkok, then you're at high-risk,' says Dr. Taylor, who experienced his worst bout of TD after enjoying a street festival in Peru.

Prevention For travelers who don't want to limit their destinations, a healthy dose of awareness can lower their risk of TD.

The CDC offers the following tips to travelers visiting high-risk locations:

Avoid cooked food that has been sitting out in the open, even if it's re-heated. Food still hot from an oven is generally safer. Avoid raw foods, especially salads and fruits (unless you can peel them yourself). Avoid seafood from tropical reefs, some of which can be toxic even after thorough cooking. Boil tap water rapidly to sterilize it, and don't add potentially contaminated ice cubes. Brush your teeth using bottled, boiled, or iodine-treated water only. Drink fluids, including water, only from bottles or cans. (Be sure to wipe lids before drinking to clear off any surface contaminants.) Feed children six months and younger breast milk or formula prepared with sterilized water. Use iodine tablets, such as Potable-Aqua, to disinfect tap water. Before you go It's a good idea to see your doctor to get medicines before you go. Dr. Taylor prescribes travelers a supply of antibiotics (typically ciprofloxacin, or Cipro) and advises them to take along antidiarrheal medicine (such as Imodium).

Treat it right away Dr. Taylor recommends that, at the first sign of diarrhea, travelers begin a two- to three-day course of antibiotics and take antidiarrheals medications (for example Immodium) as needed for more immediate relief. 'You don't get any gold stars for holding off on treatment,' he says.

He cautions against giving antidiarrheal medicine to young children. Young children with diarrhea should see a doctor early on, because they are at higher risk for dehydration than adults. For mild to moderate diarrhea in children, keep the child well dehydrated with clean water or an electrolyte replacement product such as Pedialyte. If the child's diarrhea is severe (10 or more watery stools per day) or the child is urinating less frequently (a sign of dehydration) seek medical care immediately.

Preventive medicine Antibiotics shorten the duration and intensity of most TD cases. However, Dr. Taylor says they should be used preventively only by travelers who face near certain infection, such as missionaries headed to remote villages in underdeveloped countries. Bismuth subsalicylate (found in Pepto Bismol) fights some TD bacteria, but, according to Dr. Taylor, studies have found antibiotics to be more effective at minimizing the pain and inconvenience of TD.

Stay hydrated with safe fluids When TD strikes, travelers who want to salvage valuable trip time need to do more than just take medicine. Staying well hydrated by drinking plenty of safe fluids is also essential. While this is true for everyone, it is especially important for pregnant women and children, in whom dehydration can have a more immediate and debilitating effect.

Dehydrated travelers can also find relief using oral rehydration salts (ORS), widely available in developing countries. However, ORS should not be used as a substitute for clean, plentiful water.

When to get help Seek immediate medical care for TD in any of the following situations:

Symptoms don't subside after three to seven days and/or after antibiotic treatment. You are pregnant or caring for a young child who develops diarrhea. You have a high fever and/or disorientation. You have signs of dehydration, such as decreased saliva or urination. Your stools are bloody and/or contain mucus. When you get home In some cases, TD can persist despite antibiotic treatment. Rarely, it can trigger other gastrointestinal problems. See your doctor if symptoms do not resolve after you return home.

Last reviewed: August 2001 by HealthGate Medical Review Board.

Resources Centers for Disease Control and PreventionNational Center for Infectious Diseases: Travelers' Health http://www.cdc.gov/travel/index.htm International Society of Travel Medicine http://www.istm.org/index.html

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