Traveler's Diarrhea

by Judy Peck, M.D.

General information

Typically lasts 3 to 7 days
Rarely life threatening
High risk areas: Africa, Middle East, Latin America
Acquired from contaminated food or water

Prevention

Boil it, peel it, cook it or forget it!

Food and beverages

• Safe beverages:

Tea and coffee (made from boiling water)
Bottled/canned drinks
— Coke, beer, juice, water...
— Break the seal yourself
— Wipe clean before drinking or use a clean straw
Purified local water

• Safe foods:

Well-cooked meat, fish, rice and vegetables
— Eat while hot, i.e. > 160 F


Fresh baked goods: bread, rolls, unfilled pastries


Fruits and vegetables with a peel
— Apples, bananas, oranges (peel before eating)


If you want to eat the peel
— 1/2 tsp chlorine bleach in 1 quart water
— Soak fruit 15 minutes then air dry before eating

• Risky beverages:

Unpurified local water


Ice cubes made of local water


Drinks served in a glass


All milk products

• Risky foods:

Foods derived from dairy ­ quiche, pudding...
Unpeeled or untreated raw fruits and vegetables
Food left standing at room temperature
— Buffets, rice dishes, cold meats, custards, filled pastries
Raw undercooked meat, fish and shellfish
Food from street vendors
Salads
Eggs

Rehydration

• Rehydration Beverage:

Beverage l
— Obtain WHO oral rehydration salts (ORS)
— Look for them in pharmacies of developing countries
— Mix packet in purified water as directed on the package

Beverage 2


Glass 1
— 8 oz orange, apple or other fruit juice
— 1/2 tsp honey or corn syrup
— 1 pinch table salt
Glass 2
— 8 oz safe purified water
— 1/4 tsp baking soda (sodium bicarbonate)
— Alternate drinking glass 1 and 2 when rehydrating

• How to rehydrate properly:

Choose beverage 1 or 2
Drink it as long as you continue to have diarrhea
You know you are drinking enough if your urine is light yellow or clear
Drink small sips at frequent intervals if you are vomiting

Medication

Prevention:

Peptobismal : 2 tablets or 1 oz every 6 hours for no longer than 3 weeks

Mild diarrhea:

Imodium
— 2 caps after first bowel movement
— 1 cap after each subsequent bowel movement
— 8 caps over 24 hours (maximum)

Moderate diarrhea:

Imodium as above
Antibiotics
— Levaquin or Cipro (adults)
— Bactrim DS or Septra DS (children)
Obtain the antibiotics from your doctor before you travel

• Severe diarrhea:

Levaquin, Cipro, Bactrim DS or Septra DS as above


Do not use antidiarrheals such as Lomotil or Imodium


See a physician