Prevention of Traveler’s Diarrhea

Traveler’s diarrhea can be prevented if precautions are observed properly during international travel. The main preventive measures of traveler’s diarrhea are related to food and water precautions. But studies indicate that indiscretion in eating and drinking water is done by approximately 98% of traveler’s upon arrival of their destination within 72 hours. That means only a handful of cautious travelers follow the precautions for prevention of traveler’s diarrhea. No wonder that such a large percentage of travelers suffer from traveler’s diarrhea. There is a popular slogan for travelers “Boil it, cook it, peel it, or forget it!” and it is easier to remember than following it as the studies indicate.

In general a traveler should follow some precautions for prevention of traveler’s diarrhea. The food precautions are eating food when it is still hot, avoid foods that are raw, poorly cooked, or sold by street vendors etc. Water precautions include drinking only boiled or commercially bottled beverages (preferably those that are carbonated). Heating can kill organisms that cause traveler’s diarrhea (entero-toxigenic Escherichia coli, entero-aggregative E. coli, Campylobacter, Salmonella, Shigella, rotavirus, norovirus etc.), but freezing can not kill them and due to this reason ice cubes made from unpurified water should be avoided.

Prophylaxis of traveler’s diarrhea:

The most commonly used prophylaxis for traveler’s diarrhea is bismuth subsalicylate, but it is only 60% effective. In special cases (athletes, persons with a repeated history of travelers’ diarrhea, and persons with chronic diseases) a single daily dose of a quinolone or azithromycin or a once-daily rifaximin regimen during travel of more than 1 month’s duration is effective in preventing travelers’ diarrhea in 75% to 90% of cases.

Self treatment of traveler’s diarrhea:

Ideally all travelers should carry some medication for traveler’s diarrhea for self treatment of traveler’s diarrhea, as it can occur despite rigorous food and water precautions. An antibiotic can reduce the frequency of stools and duration of illness in moderate to severe diarrhea. The standard regimen for traveler’s diarrhea is a single daily dose of quinolone (ofloxacin, ciprofloxacin etc.) for 3 successive days. Rifaximin, a poorly absorbed rifampin derivative and is highly effective against noninvasive bacterial pathogens like entero-toxigenic E. coli and entero-aggregative E. coli. But if you acquire traveler’s diarrhea, in Thailand, where more than 90% of Campylobacter infections are quinolone resistant, azithromycin can be a good choice.

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