How Not to Die from (and avoid) Traveler’s Diarrhea
Turkey 1993
That’s me, on my first trip with my soon to be husband, Tom. This was the summer before I started medical school and I accompanied him (and helped by holding the site poles for hours in the hot sand) while he performed surveying work for several archeological sites in Israel and Turkey. I experienced two bouts of gastrointestinal illness on that trip. I felt so bad I thought I might just die. They were very traumatic experiences but I am happy to report that I can finally consume feta cheese again after 25 years of aversion!
PREVALENCE:
countries shown in red and yellow have a higher prevalence of Traveler's Diarrhea - GO PREPARED
Common Travel-Related Illness: Traveler’s diarrhea is the most predictable travel-related illness, affecting 30% to 70% of travelers depending on the destination and season 1.
High-Risk Areas: Higher prevalence in regions with poor sanitation and hygiene practices, such as parts of Asia, Africa, Latin America, and the Middle East (see map above) 2.
People At Risk: those who have a poor immune system (autoimmune diseases, diabetes, heart disease, cancer), the very young (children under the age of 5 can become dehydrated very quickly) older folks, people who chronically take proton pump inhibitors (omeprazole, pantoprazole, lansoprazole, etc.)
young children and infants are at high risk for dehydration with diarrheal illnesses
SYMPTOMS:
Common Symptoms:
Abdominal cramps and pain (severe pain should always be investigated by a medical provider) 2.
Severe Symptoms:
Fever greater than 102 F
Dehydration (dry lips, not producing clear urine, weakness, low blood pressure, lethargy in children) 2.
Bloody stools (may be black or tarry. Be aware, however, that Pepto Bismol will turn your stools black) 2.
Persistent vomiting (several times an hour and/or lasting more than 24 hours) 2.
Severe abdominal pain should ALWAYS be evaluated by a medical provider
TREATMENTS:
A homemade oral replacemnet solution can be made from ordinary hotel sugar and salt packets
Bismuth subsalicylate (Pepto-Bismol)
Self-Care:
Hydration: Oral rehydration solutions (ORS) or sports drinks to replace lost fluids and electrolytes 3.
WHO recipe for a homemade solution: mix 6 tsps of sugar (1 standard hotel/restaurant packet contains about 1 tsp of sugar) and 1/2 tsp of table salt (1 standard restaurant salt packet contains about 1/4 tsp of salt) with each Liter (5 cups) of water. Drink mixture after every loose bowel movement. https://rehydrate.org/faq/how-to-prepare-ors.htm
Drip Drop oral hydration packets are another great option and are easy to travel with.
Medications:
Anti-Diarrheal Agents: Loperamide (Imodium AD) to reduce the frequency of stools 5. DO NOT use in children under 2 or more than 16 mg a day - can cause heart arrhythmias at high doses
Bismuth subsalicylate (Pepto-Bismol) 2 tabs every hour up to max of 8 tablets in 24 hours
Anti-nausea medications, antihistamines and antacids will all slow your gut down.
Antibiotics: Ciprofloxacin or azithromycin (ask your medical provider for a prescription to take with you on your trip) for severe cases or when bacterial infection (bloody stools and fever) is suspected 5.
PREVENTION:
Safe Eating and Drinking Practices: Avoiding street food, drinking only bottled or treated water 2.
Bismuth subsalicylate (Pepto-Bismol) 2 tabs twice a day (for up to 3 weeks) during travel
Probiotics: Consider taking a good (greater than 10 billion CFU, multistrain) probiotic starting 1 week prior to and all during travel.
Boil or filter all drinking water (Don't forget to avoid the ICE). Wash all fruits and veggies. Don't eat street food (particularly feta cheese).
References:
