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Traveler's Diarrhea

What is Traveler’s Diarrhea?
Traveler’s diarrhea (dysentery, Montezuma’s revenge) is usually a self-limiting episode of diarrhea that results from eating food or water that is contaminated with bacteria or viruses.  Traveler’s diarrhea is most common in developing countries that lack resources to ensure proper waste disposal and water treatment.  Onset is often sudden and usually lasts 3-5 days or longer. The severity of diarrhea can vary and can be accompanied by cramps, bloating, nausea, vomiting and /or fever. In severe cases, life-threatening dehydration can occur, especially in babies, young children and the elderly.  It is estimated that up to 40% of travelers experience some form of traveler’s diarrhea. 

How can I prevent traveler’s diarrhea?
The best practice is to avoid eating and drinking food and water that are contaminated with human waste (stool, feces). This can be accomplished by:

  • Drink beverages made only with carbonated bottled water or water that has been boiled, filtered or chemically treated.
  • Drink canned or bottled water or juices.
  • Open the cans or bottles yourself and wipe off the opening before drinking. You can also use a straw to drink from.  It is an occasional practice for unscrupulous vendors to refill bottles with tap water and sell it as bottled water.
  • Use boiled or bottled water to brush your teeth.
  • Avoid ice cubes unless they have been made with boiled water.
  • Drink only pasteurized dairy products.
  • Keep your mouth closed in the shower and tub.
  • Eat only well cooked, hot food.
  • Eat fruits, vegetables and nuts that you have peeled or shelled yourself.
  • Avoid lettuce, uncooked vegetables or cold meat.
  • Avoid food from street vendors or any other place that does not appear clean.
A rule of thumb is “COOK IT, PEEL IT, BOIL IT, OR FORGET IT”.  Frequent hand washing is also an effective way to help prevent traveler’s diarrhea as well a number of other infections.

How do I cure traveler’s diarrhea?
The most important part of treating diarrhea is to avoid dehydration.  You need to drink non-alcoholic, non-caffeinated liquids or oral rehydration solution and eat salted crackers.  If nausea is present, take fluids in small amounts, frequently.  This is especially true for infants.  Make sure that the fluid you take is pure (boiled or bottled).  You can progress to rice, bread, potatoes and soups if fluids and crackers are tolerated. 

Seek medical help if signs of dehydration occur – dizziness, weakness, dry skin and mouth, lack of tears or urine and sunken eyes.  Also seek medical help if diarrhea persists for more than 3 days.

When diarrhea starts or when it is mild, take over the counter medicines such as Pepto Bismol or Imodium as directed.  Avoid taking Imodium for more than 48 hours.  Read all package instructions.

When should I take Cipro (Ciprofloxacin)?
Cipro or another antibiotic is recommended if the diarrhea is frequent or accompanied by cramps or nausea.  Take one Cipro pill every 12 hours.  If the diarrhea continues, repeat the Cipro. 

You may repeat Cipro every 12 hours until the symptoms subside.  When you feel better, stop taking the Cipro.  Most people will get relief after one, two or three tablets.

When should I take Azithromycin (Zithromax)?
In some areas of the world one or more of the disease causing organisms are resistant to Cipro making it less effective.  In these areas, the drug of choice is Azithromycin.  If over the counter medicines are not working or if the diarrhea involves frequent loose stools or cramps or nausea, Azthromycin may be taken. 

Take one pill of Azithromycin pill every 24 hours until relief is obtained.  Often, one pill will induce relief.  Limit is 3 days of treatment then see a doctor.  (see below)

When should I see a Doctor?
You should see a doctor IF:
  • 6 tablets of Cipro, 3 tablets of Azithromycin do not give relief.
  • You have signs of dehydration such as dizziness, weakness, dry skin, lack of tears or urine or sunken eyes.
  • The diarrhea becomes more severe, painful or if blood or mucus appear in the stool.
  • You develop a rash or hives (this may indicate an allergic reaction).

Remember: Cipro is not recommended for pregnant women and children under 18.

NOTE: If you suspect that you have cholera, you should take Cipro or Azithromycin for 3 days.

BE SURE TO READ ALL THE PRESCRIBING INFORMATION PROVIDED BY YOUR PHARMACY!

For more information, contact:
Indiana University Health Center
Travel Clinic
600 North Jordan Ave.
Bloomington, IN  47405
812-855-7514
http://www.indiana.edu/~health