Tips from gaining health

What is travelers diarrhea the truth about diarrhea

Travelers’ diarrhea is often used as a generic term  for any illnesses ranging from an upset tummy to  loose stools during or after travel. It could mean just excess gas, or a variety of symptoms that can occur from a change in the types of food or beverages we are used to – or, most commonly, to contamination of food or beverages. And its not just food and beverages. Touching your mouth or nose with contaminated hands may be all it takes.
How can I prevent travelers diarrhea?

People often discuss the importance of care in selecting "safe" foods and beverages for consumption. We recommend that foods be freshly cooked and be piping hot; such foods are safer than those on a buffet that have been sitting out for hours. Water should be bottled and sealed, or boiled. Alcohol is OK, but ice cubes are not.

Can medications prevent travelers diarrhea?

Yes. Pepto-Bismol has been used for a number of years to prevent travelers diarrhea. Studies show that if adults take the equivalent of two tabs four times a day, it can decrease the incidence of travelers’ diarrhea up to 60%.

Now, many people who take that amount of Pepto-Bismol end up with severe constipation. I take two tabs twice a day when I go into a risky situation. I do believe that it is very helpful, but most recommend if you’re going to do this, that it should just be for short-term -- up to three weeks.

While this helps many people, those allergic to aspirin cannot take it. And if youre taking prescription medications, you should check with your doctor to see if you can take this.

Some swear by probiotics like lactobacillus for preventing travelers diarrhea. But studies of this strategy in limited numbers of subjects are inconclusive.

And some people are given prophylactic antibiotics, which are very effective in preventing travelers diarrhea, but the problem there is we dont feel very good about prescribing antibiotics for a number of reasons for someone if they don’t need them. There are issues such as side effects, or of diarrhea caused by the antibiotics themselves, and increased antibiotic resistance in the normal organisms we harbor in our bodies. Rarely, if it is just for a very important weekend, or occasionally for government officials or someone in an athletic competition, we may prescribe preventive antibiotics.

How can a change in diet trigger travelers diarrhea?

Its due to eating different kinds of foods, such as much more spicy food or more fat than in our normal diets. That is not something we typically pay as much attention to avoiding when we travel, but we have to be wary of these things. Not every change in our bowel habits is due to infection. Infection is the most important cause of travelers diarrhea and most is caused by bacteria.
Who is most likely to get travelers diarrhea?

Some people are more susceptible than others, its not clear why that is. You can be with a group and all consume the same thing, and some get sick while others do not.

There are a host factors involved. Stomach acid is our first defense mechanism against organisms that we ingest. Theore, those on antacids, or who just have low stomach acid, often get travelers diarrhea more easily. People who have underlying diseases of the gut, such as Crohn’s disease or AIDS, may be more susceptible to certain types of organisms causing travelers’ diarrhea.
What kinds of infection cause travelers diarrhea?

For the most part, were talking about bacterial infections. Almost 90% of travelers diarrhea cases are caused by bacteria. The enterotoxigenic E. coli [ETEC, strains of common bacteria that produce a toxin affecting the gut] are most important cause. And then there  are others such as salmonella, shigella, campylobacter, vibrio, and others that are less common.

Travelers diarrhea may also be caused by viruses, such as norovirus, which is in the news a lot because of how quickly it can spread through a cruise ship.

Parasitic travelers diarrhea is yet another kind. Giardia intestinalis is the most common of these, but there is a large number of parasites that can cause diarrhea. These are less frequent.
Aside from the obvious, how do you know youre coming down with travelers diarrhea?

Sometimes it starts with fever and chills. You may get cramps, and then, of course very urgent loose stools in various amounts. Sometimes there is vomiting or bloody diarrhea. With norovirus, onset can be sudden, and vomiting is a much more prominent feature.

For bacterial and viral travelers diarrhea, the incubation period is typically six to 48 hours after infection.

For protozoan travelers diarrhea, there is usually more of a gradual onset with a few loose stools  per day and increased gas and nausea. The incubation period can be one to two weeks.
What is the main treatment for travelers diarrhea?

Hydration is the primary treatment. Often people with a bout of travelers diarrhea feel so weak. A good deal of  it is due to dehydration. Its not OK just to take a few sips of cola. You need to make the effort to drink a lot of fluid, because often youve lost a lot more than you think. In a lot of cases, just clean water is OK. Better, if you are very dehydrated, is a rehydration solution. Rehydration packets are a great thing to have, especially if you are going to remote areas or places off the usual tourist paths.

What antibiotic should I take for travelers diarrhea?

It depends. For adults, ciprofloxacin is used most commonly. Sometimes, for those traveling to certain places in Southeast Asia, where bacterial pathogens have increased resistance, some doctors like to prescribe azithromycin. In some cases where you feel that the traveler may likely be exposed to just the coliform pathogens such as E. coli, some prescribe rifaximin.

Of course, antibiotics work only for bacterial causes of travelers diarrhea. Know that even bacterial travelers diarrhea usually gets better without antibiotic treatment, although rehydration is always advised and symptoms may take 3 to 5 days or more to subside without treatment.

For those with diarrhea due to parasitic infections, there are agents that are specific for each type of infection. However, for Giardia infections, tinidazole [Tindamax] is often prescribed and is very effective.

All of this advice applies to adults. What about children?

Kids can become dehydrated far quicker than adults. Rehydration solutions are more important for children right from the outset.

Doctors are now becoming more open to prescribing antibiotics that children can take in case they get travelers diarrhea. Azithromycin can be useful in children. Parents should check with their pediatricians before leaving home.

Nursing mothers should continue to breastfeed. The time to wean a child is not in the middle of travel. Continue even if the mother has diarrhea -- but she must ensure that she is getting plenty of hydration.