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Traveler’s diarrhea meds

This is a practical guide to Traveler’s diarrhea meds.

The best part?

We’ll give you only factual information based on reliable sources and our nearly 20 years of experience in travel medicine.

Travelers diarrhea overview: what you need to know about signs and symptoms

What is a travelers’ diarrhea?

Travelers’ diarrhea, [1] Travelers’ Diarrhea https://wwwnc.cdc.gov/travel/yellowbook/2024/preparing/travelers-diarrhea or ‘food poisoning”, is the most widespread health condition among tourists. According to the World Health Organization (WHO), this condition affects over 50% of international travelers. It mostly occurs among travelers visiting the developing regions of the world (Central and South America, Africa, Asia).
People mainly get it when they consume contaminated food or water. In the majority of cases, this illness is caused by bacteria. However, in some cases the travelers’ diarrhea may be caused by a viral infection, such as norovirus or rotavirus. The condition often occurs between 4-14 days after a tourist arrives in a foreign country. Usually, the illness disappears within 5 days without any treatment.

What are the signs and symptoms of travelers’ diarrhea?

People with traveler’s diarrhea experience loose stools with or without abdominal pain, fever, and nausea. However, based on the overall health status and frequency of the bowel movements of a person, travelers’ diarrhea is conditionally categorized into 3 groups of severity, namely mild, moderate, and severe. Disease manifestation varies from group to group.

Severity
Mild Moderate Severe

Symptoms:

  • Diarrhea is tolerable
  • 1-2 unformed stools within a day (24 hours)
  • Other symptoms are absent
  • Diarrhea is not distressing
  • Travelers are able to perform planned activities

Symptoms:

  • 1-2 unformed stools within a day (24 hours) along with nausea or fever or belly pain or blood in stools or vomiting
  • More than 2 episodes of unformed stools within a day (24 hours) when other symptoms are absent

Symptoms:

  • 3 or more episodes of unformed stools within a day (24 hours) along with nausea or fever or belly pain or blood in stools or vomiting
  • Travelers are unable to perform planned activities

Diarrhea medications after getting it: what, when and how

Imodium: when to start it and how to take it?

Imodium (Loperamide) is a famous antimotility medication that helps to deal with symptoms such as frequent and watery stool. However, it is important to know that this medication does not treat the infectious disease. That is why for international travelers with symptoms of severe diarrhea it is suggested to take Imodium alongside antibiotics. Those having mild or moderate diarrhea may take it without antibiotics. Children aged two years old and younger should avoid this medication.
The table below summarizes information on dosage of the medication for travelers of different age groups

Age Group Dosage

2-5 years old

  • First dose- 4 mg per diarrhea episode
  • Next doses- 2 mg per diarrhea episode

( the maximum dosage is 16 mg a day)

6-11 years old

  • First dose- 2 mg per diarrhea episode
  • Next doses- 1 mg per diarrhea episode

( the maximum dosage is 6 mg a day)

12 years old and older

  • First dose- 1 mg per diarrhea episode
  • Next doses- 1 mg per diarrhea episode

( the maximum dosage is 3 mg a day)

The role of Charcoal in travelers’ diarrhea

This medication is helpful in the treatment of some types of poisoning. However, it is not effective in the prevention or treatment of diarrhea and gas.

How do I know when to take antibiotics?

Antibiotics should not be taken for the mild and moderate types of travelers’ diarrhea. [2] Travelers’ Diarrhea https://www.aafp.org/pubs/afp/issues/1999/0701/p119.html Mostly, this medications are recommended when:

  • Traveler has a severe infectious diarrhea
  • Traveler has pus or blood in the stool
  • Traveler cannot perform planned activities because of diarrhea

Nowadays, the antibiotics that are indicated for this condition are Azithromycin, Rifaximin or Fluoroquinolones with the following dosages:

  • Azithromycin  (1 g) single dose of Azithromycin  (500 mg) once in a day (for 3 days)
  • Fluoroquinolones  (400 mg) twice a day (for 3 days)
  • Rifaximin  (200 mg) 3 times a day (for 3 days)
Treatment options for different types of travelers’ diarrhea

In summary, treatment options for travelers’ diarrhea are tailored to the severity of diarrhea. The table below describes the suggested treatment options for each group of the severity of diarrhea.

Severity Symptoms Treatment

Mild

  • 1-2 unformed stools within a day (24 hours)
  • Other symptoms are absent
  • Travelers are able to perform planned activities (for example, they may spend as much time outdoors as they want and be physically active as much as they were before diarrhea)
  • Oral rehydration solution
  • Imodium or Bismuth subsalicylate
  • No antibiotics are needed

Moderate

  • 1-2 unformed stools within a day (24 hours) along with nausea or fever or belly pain or blood in stools or vomiting
  • More than 2 episodes of unformed stools within a day (24 hours) when other symptoms are absent
  • Travelers have difficulties to perform planned activities (for example, they may spend as much time outdoors as they want and be physically active as much as they were before diarrhea)
  • Oral rehydration solution
  • Imodium + one of the antibiotics mentioned below:
  • Azithromycin (1g) single dose of Azithromycin (500mg) once in a day (for 3 days)
  • Ciprofloxacin(400mg) twice a day (for 3 days)
  • Rifaximin (200mg) 3 times a day (for 3 days)

Severe

  • 3 or more episodes of unformed stools within a day (24 hours) along with nausea or fever or belly pain or blood in stools or vomiting
  • Travelers are unable to perform planned activities (for example, they may spend as much time outdoors as they want and be physically active as much as they were before diarrhea) because of multiple episodes of unformed stools and overall weakness.
  • Oral rehydration solution + one of the antibiotics mentioned below:
  • Azithromycin (1g) single dose of Azithromycin (500mg) once in a day (for 3 days)
  • Ciprofloxacin(400mg) twice a day (for 3 days)
  • Rifaximin (200mg) 3 times a day (for 3 days)

Best practices to prevent diarrhea while traveling

How to minimize travelers’ diarrhea?

There are several recommendations that need to be followed to prevent travelers’ diarrhea when traveling to high-risk regions (Middle East, Southeast Asia, Africa, Latin America, Mexico, and the Caribbeans).
The tables below summarize these recommendations.

Prevention of Travelers’ Diarrhea Without Medication
Clean Your Hands Eat Safe Food Drink Safe Water
  • You’re your hands before eating
  • Wash your hands after being in the bathroom
  • If you cannot wash your hands, use sanitizer containing minimum 60% alcohol
  • Eat cooked food
  • Meal should be hot when it's served
  • Consume only pasteurized milk products
  • Peel the fruits right before consuming them
  • Drink tea and coffee made with boiled water
  • Avoid tap or stream water
  • Shower with a closed mouth
  • Boil water for 3 minutes
  • Brush your teeth with bottled water
  • Drink water directly from the bottle
Can I eat fruits? Do I need to peel them off?

Fruits are one of those products that are often contaminated, which is why they are a common risk factor for traveler's diarrhea. However, travelers can eat fruits, but only the ones that they can  easily peel themselves, like:

  • Bananas
  • Oranges

It is recommended to avoid   the consumption of fruits that cannot be peeled, such as:

  • Berries
  • Grapes
  • Plumps
  • Also, it is important to know that fruits should be peeled right before eating.
How to wash the fruits to prevent travelers’ diarrhea??

Fruits should always be washed before eating. However, in developing countries, water is often contaminated, thus, may cause diarrhea in travelers. Unsterilized water should always be avoided. It is recommended to use boiled (for 3 minutes) or bottled water when washing hands, fruits, and teeth. Moreover, travelers should avoid sliced fruits, ice cubes and juices since those may be made from tap water.

Prevention of travelers' diarrhea with medication: pros and cons
Prevention of Travelers’ Diarrhea With Medication
Non-antibiotic Prophylaxis Antibiotic Prophylaxis
  • Bismuth subsalicylate (30ml) 4 times a day
  • Lactobacillus GG
  • Rifaximin (200mg) 3 times a day
Non-antibiotic prevention of travelers' diarrhea

One of the most commonly used non-antimicrobial prophylactic medications is Bismuth subsalicylate (Pepto-Bismol ). According to the Centers for Disease Control and Prevention (CDC), travelers who take this over-the-counter medication have up to 50% lower incidence of travelers’ diarrhea. Some studies claim that its preventive efficacy is more than 60% higher than placebo. However, Bismuth subsalicylate should not be taken by:

  • Children aged 3 years old and younger
  • Tourists having aspirin allergy
  • Pregnant women
  • Tourists having renal insufficiency
  • Tourists having gout
  • Tourists taking other medications such as anticoagulants, probenecid, and/or methotrexate

Moreover, those who take Bismuth subsalicylate may develop side effects such as nausea, hard stool (infrequent bowel movements), and blackening of the stool and/or tongue.

The next medication that is helpful in both the prevention and treatment of travelers’ diarrhea is Lactobacillus GG (probiotic). This medication helps to prevent diarrhea by increasing the number of good bacteria that help to defeat the pathogenic (bad) bacteria.

Prevention of travelers’ diarrhea with antibiotics

Though antibiotics are effective in the prevention of travelers’ diarrhea [3] Traveler's diarrhea https://www.mayoclinic.org/diseases-conditions/travelers-diarrhea/diagnosis-treatment/drc-20352188 development (more than 90%  of cases may be prevented), their routine use is not recommended. The thing is that antibiotics have various disadvantages:

  • They are expensive
  • They may cause vaginal yeast infection
  • They may cause skin rash and allergy
  • They disrupt the growth of normal (good) bacteria
  • They promote antibiotic resistance

However, health care providers suggest that in some cases, the benefits of taking antibiotics outweigh its disadvantages. These is true for:

  • Tourists with health conditions that can lead to diarrhea-related complications such as severe inflammatory bowel disease, kidney diseases, and suppressed immunity (for example HIV).
  • Athletes attending tournaments or competitions that cannot afford to become sick

Ideal way of diagnosing travelers' diarrhea and when I need it

How is travelers’ diarrhea diagnosed?

Usually, travelers diagnose the condition by themselves. Yet, some specificities may help to identify the causative agent and come up with an effective treatment strategy. The symptoms and possible pathogens are described below:

Symptoms Examination Possible Pathogen
  • Abdominal cramping
  • Blood in the stool
  • Fever

Stool culture

  • Campylobacter
  • Shigella spp
  • Enterotoxigenic escherichia coli (E. coli)
  • Often feeling sick

Blood culture

  • Salmonella species
  • Bloating
  • Gas
  • Nausea

Stool culture

  • Giardia
  • lamblia,
  • Cyclospora
  • Isospora
When to see a doctor?

Usually, travelers’ diarrhea [4] Prevention and Self-Treatment of Traveler's Diarrhea https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1539099/ will be gone, without any treatment. However, there are some cases when a patient should see a travel medicine provider. Those cases are:

  • If a traveler has a high fever
  • If a traveler has bloody diarrhea
  • If a traveler has bloody vomiting
  • If a traveler has severe abdominal pain
  • If antibiotics are ineffective (patients have symptoms for more than 2 weeks)
What if travers’ diarrhea persists after treatment?

If travers’ diarrhea lasts for more than 2 weeks it is considered persistent diarrhea. Usually, this condition is a result of antibiotic-resistant bacteria. In his case, it is recommended to identify the pathogen and undergo a targeted therapy.

Conclusion

Travelers’ Diarrhea is an extremely widespread condition among people visiting foreign countries. This condition may resolve by itself. However, it may give a lot of inconveniences and destroy the whole journey. That is why, before the trip, it is recommended to read trustworthy health information for international travelers, follow the preventive recommendations and get the right treatment on time.



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