The raw egg breakfast at the hawker stall was a culinary adventure, the yolk still slightly runny and I savored every bite. However, after breakfast as I walk to my next sightseeing destinations, a wave of nausea washed over me. My stomach lurched, and a cold dread settled in. The urge for diarrhea was immediate and intense. Panic surged through me as I frantically searched for the nearest restroom. The relief was short-lived, followed by a wave of weakness and embarrassment. This cycle repeated. My sightseeing plans evaporated faster than the morning dew due to traveler’s diarrhea.
- What is traveler’s diarrhea
- How do we get traveler’s diarrhea?
- What is most important when you get traveler’s diarrhea?
- How to prevent traveler’s diarrhea?
- Are there medications or vaccines available for prevention?
- Are there medications available for treatment?
- When to get help?
What is traveler’s diarrhea?
Traveler’s diarrhea is a travel-related disease with the symptoms of frequent loose or watery stools along with cramps, nausea and possibly fever(1). Bacteria such as E.coli is the most common cause of traveler’s diarrhea followed by viruses and microscopic parasites(1).
How do we get traveler’s diarrhea?
Common causes include inadequate hygiene and sanitation related to the processing and storage of food(1). Traveler’s diarrhea usually occurs within a few hours of consuming contaminated food(2). Fortunately, most cases are mild and resolve on their own within a few days(2). However, it can significantly disrupt your travel plans.
What is most important when you get traveler’s diarrhea?
It is important to prevent dehydration by replacing fluids and electrolytes lost during traveler’s diarrhea. For mild dehydration, liquid such as sports drink or other liquids except drinks that are too sweet can be considered(2). However, the drink should be sealed, boiled or chlorine treated(2). For severe dehydration, oral rehydration salts can be used(2).
How to prevent traveler’s diarrhea?
According to CDC, the following methods can help prevent traveler’s diarrhea(2):
- Avoid raw or not fully cooked food (ex. meat, seafood, salad)
- Avoid unpeeled fruits
- Wash hands with soap and water or use hand sanitizer >= 60% alcohol
- Drink boiled, disinfected, filtered or bottled unopened water
- Avoid ice cubes or ice in drinks
- Use liquid, ready-to-feed formula
- Use hot water (≥158°F; ≥70°C) to reconstitute powder formula
Are there medications or vaccines for prevention?
Bismuth Subsalicylate (Pepto-Bismol, Gastrovol): Two 262mg (=524mg) four times daily seems to provide a 50% to 65% protection rate(3,4)
Dukoral (oral vaccine for Cholera and Enterotoxigenic Escherichia coli (ETEC) which is the most common cause of traveler’s diarrhea)(currently not available in US, available in Canada)(5):
- For 2 years and older:
- 2 doses 2 weeks apart
- First dose at least 2 weeks before departure and second dose at least 1 week after 1st dose
- If more than 6 weeks between first and second dose, the 2 doses have to be repeated
- According to the manufacturer, Dukoral had an 86% protective efficacy against clinically severe ETEC traveler’s diarrhea(5). However, as most cases resolved on their own within a few days(2), the Canadian Immunization Guide finds that the overall protection of Dukoral against traveler’s diarrhea is approximately 6%(6).
Antibiotics for prevention: not recommended for most travelers due to risk of resistance(4).
Are there medications available for treatment?
Oral Rehydration Salts (Hydralyte, Pedialyte): the ratio of electrolytes (salts) that is needed for our body to recover or prevent dehydration(7).
Loperimide (Imodium): slow the movement of the intestines which slows down the time for fluids and food to pass through the intestine(8). This slowing of the intestine allows fluids and salts to be absorbed back to the body and minimizing diarrhea output(8).
- As per Imodium Canada, for adults and children 12 years and older: 2 capsules as first dose, then 1 capsule after each bowel movement. Max 8 capsules per day(9).
Antibiotics: antibiotics may be effective in decreasing the duration of traveler’s diarrhea by 1 to 2 days if the cause of the diarrhea is bacteria based and sensitive to the antibiotic taken(4). However, drug resistance and the affect on the individual ‘good’ bacteria are concerns(4).
- Common antibiotics used include:
- Azithromycin: 1000mg as a single dose or 500mg once daily for 3 days(4).
- Ciprofloxacin/Levofloxacin: increasing resistance especially in South and Southeast Asia(4).
- Levofloxacin: 500mg once daily for 1 to 3 days(4).
- Ciprofloxacin: 750mg as a single dose or 500mg twice daily for 3 days(4).
When to get help?
Consult a physician or local health professional if diarrhea is severe especially with high fever or bloody stools(3).
Disclaimer: The information provided on this blog is for general knowledge and educational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Medications and/or vaccines mentioned in this article is not suited for everyone. All medications can contain side effects, contraindications and interactions, check with your pharmacist or healthcare provider if it is suitable for individual needs.
References
(1) https://www.canada.ca/en/public-health/services/diseases/diarrhea.html
(2) https://wwwnc.cdc.gov/travel/yellowbook/2024/preparing/food-and-water-precautions
(3) https://www.aafp.org/pubs/afp/issues/1999/0701/p119.html
(4) https://wwwnc.cdc.gov/travel/yellowbook/2024/preparing/travelers-diarrhea
(5) https://dukoralcanada.com/dukoral-dosing-administration/
(7) https://travel.gc.ca/travelling/health-safety/rehydration
(8) https://www.imodium.com/anti-diarrhea-medicine/how-imodium-works
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