As if the nausea, vomiting, and abdominal pain weren’t enough, you notice blood on the 80 grit toilet paper that the maid refuses to bring you anymore of. She says, “You too much poop. More paper for you, no.” Fortunately, you prepared ahead of time, hid a roll of paper, and knew how to treat traveler’s diarrhea. Feeling better in 2 days, you were able to snatch the maid’s cart at night and leave it a few hundred yards down the main dirt road.
In the United States you wonder how many restaurant employees observe the “Wash Hands Before Returning To Work” sign…. These signs don’t exist in many foreign countries.
Traveler’s diarrhea, or gastroenteritis typically includes vomiting and diarrhea and is caused by bacteria, occasionally viruses, and rarely parasites. Most often it is caused by the bacteria E. coli. Symptoms typically begin 12-72 hours after contaminant ingestion. These can also include muscle aches and fever. In general, most cases are self-limiting and mild.
Sources are contaminated water and food. Prevention is aimed at avoiding the latter.
- Insure all bottled water and drinks are clean, including around the sealed cap. It is not uncommon for venders to keep drinks cool in tubs of contaminated ice water.
- Brush teeth with bottled water.
- Although drinks may be bottled, avoid using local ice in a glass.
- Insure restaurants have good sanitary conditions. This can best be done by avoiding street vendors and sticking with reputable restaurants.
- Take extreme precautions if you are taking medications for your stomach that decreases stomach acid.
- Wash hands often. Alcohol containing towelettes and disinfectants are easy enough to carry with you and do work.
- Avoid buffets, vendor’s food left sitting out, including baked goods.
- Peel your own fruit after washing in a mild bleach solution (1/2 shot glass of bleach to 1 gal. of water.)
- Portable water filters now exist that filter water to 0.2 µm.
- On my sailing vessel, I put bleach in the water tanks at a concentration of 1/8 shot glass/gal. Chlorine also comes in tablets if you prefer not to carry a jug with you.
- Iodine tablets kill most viruses, bacteria, and protozoans. Caution: do not use if the possibility of pregnancy exists or if you have a thyroid disorder.
- There are portable UV devices out now for sterilizing water but I have no experience with these.
- The boiling point of water at sea level (lower with increased altitude) is 212° F (100° C), however, water heated to 158° F (70°C) for 10 minutes will kill most bacteria.
- As far as I am aware there have been no conclusive studies on pro-, pre-, or synbiotics in the treatment or prevention of traveler’s diarrhea.
- Avoid raw shell fish and seafood, raw salads and eggs, and unpasteurized ice cream.
- Note: I have seen crooked vendors uncap bottles and fill them half full with tap water that was possibly contaminated. It’s well known among sailors in distant ports that bottled beer is often the only safe thing to drink. So, there’s an option of staying drunk all of the time and you may not have diarrhea.
Usually clinical and based on symptoms. However, if you have the following symptoms, consult a physician if possible:
- Elevated temperature (Usually over 101 F).
- Severe abdominal pain.
- Bloody diarrhea.
- Symptoms persisting over 2-3 days.
- Signs of dehydration or early shock (discussed elsewhere).
- Moderate to severe diarrhea (defined as 3 or more loose stools over an 8 hour period).
- There are several manufacturers of easy to carry tablets and powders.
- Antibiotics if moderate or severe diarrhea. For adults: Ciprofloxacin 500mg p.o. bid for 3 days or Levofloxacin 500 mg p.o. once a day for 3 days. An alternative is Azithromycin 250 mg p.o. once a day for 3 days. For children, Azithromycin 5-10 mg/kg once a day for 3 days.
- Note: Persons with immunocompromising conditions may want to discuss taking one of the above medications preventatively. Otherwise, weighing the risks and possible benefits, I think it prudent to ask your doctor to prescribe these medications, to have on hand, just in case, before any foreign travel.
Final note: Many times traveler’s diarrhea (gastroenteritis) is referred to as “dysentery” as a catch all term. However, dysentery, medically, is usually reserved for more severe forms of gastroenteritis such as that caused by Shigella or amebiasis requiring cultures and more aggressive treatment. Patients are typically sicker with bloody diarrhea.
On the lighter side of life:
Yes, I have had the old traveler’s diarrhea a few times myself. Once, on a medical mission trip to Guatemala’s primitive interior, my group stopped at a predetermined village. Riding in the back of a dusty flatbed truck on cratered roads all morning and rafting on washing machine rapids all afternoon, we looked forward to stopping and setting up camp. The natives helped us put up tents on the outskirts of their primitive village. Camp set up, most of us headed to the river with a bar of soap to bath and swim in the moon light. Exhausted, I retired to my tent and immediately fell asleep. At daybreak I woke up to torrential rains, typical summer sub-tropic weather. The mud outside was ankle deep. Asking a village kid where I could go to defecate, he pointed to a deep gully. Walking along a mud path and down a bank I watched white and brown paper and elements of corn, the local’s primary food source, being washed into the river. Although half asleep, it dawned on me that this gully was a sewer and it was upstream from the area we had been swimming in the night before.
Fortunately, my group was prepared and had brought along Septra, an antibiotic used at the first sign of symptoms. Ummm… I didn’t go swimming there anymore!