Travel-Related Illness: Montezuma's Revenge (cont.)

The medication in Mexico should be as safe as the equivalent product in the U.S. The problem is whether or not the correct medication was obtained. In other words, if you know exactly what you're buying, in terms of the milligrams and name of the drug, I would be perfectly fine with purchasing that product in Mexico. But I wouldn't trust the pharmacist in Mexico to tell me what I needed for a medical condition. They probably are trained, but I think US people expect a higher level of help than might be expected at such a pharmacy.

I've made it a habit of going to pharmacies around the world and asking them how they would treat common problems and I haven't been very impressed with the quality of their advice as a whole.

I am going to Guatemala City this fall for a week. Some people say I need shots; some say if I'm only in the city I just need a box of Imodium and I'm all set. What do you think? Oh, and is the old "don't drink the water" adage still true?

Terrific question. The major things to worry about in Guatemala City are twofold:

The most important vaccine-preventable disease of travelers is Hepatitis A. The chance of getting hepatitis when a traveler goes to a country like Guatemala is 1-5/1000. There's a vaccine available for Hepatitis A that's taken in two doses, rendering protection for more than 20 years, so we recommend for all travelers to any developing country to take this vaccine.

The other problem, as you suggest, is diarrhea. It is actually not the water that's the problem, but it's contaminated food. Food in countries like Guatemala can be categorized as usually safe or often unsafe. The usually safe items are:

  • Those served steaming hot
  • Those that are dry, like bread
  • Those with high sugar content, like syrup, jelly, and honey
  • Any fruit that can be peeled or has been peeled
  • Items that have high acid content, like citrus

The often-unsafe foods are the ones that are served at room temperature that contain moisture. So this would be vegetables and things that haven't been properly washed and other foods that are sitting in warmers that are not maintained at high temperature. The causes of this common diarrhea are bacterial agents found in these food items.

While Imodium will treat the symptoms very effectively, it may not cure the infection. We have known for at least 23 years that antibiotics are the mainstay of treatment of this diarrhea. Probably the best treatment is to combine a drug like Imodium with an antibiotic, where you get the immediate effect of the Imodium and the curative effect of the antibiotic.

What antibiotic would you recommend?

I think that's a real key question. We really have several possible medications we use that seem to work. The drug I favor right now is one that's just been approved by the FDA and will be in drugstores in the next week or two. It's called Xifaxan, which has a couple of advantages over other medications available. The main advantage is that it's not absorbed from the intestinal tract, which means it will not cause symptoms of headache, insomnia, vaginal infection, skin rashes, and the other problems with other antibiotics that are absorbed from the intestinal tract. So it's entirely safe with essentially with no side effects. It's very effective on the majority of the cases of diarrhea that occur.

Xifaxan is taken in a dose of one tablet three times a day for three days. This antibiotic and others are used for traveler's diarrhea, but not for cruise-related Norwalk gastroenteritis.

I'm planning the trip of a lifetime -- China and Tibet. What do I have to do to prepare for the altitude in Tibet?

The key items, like everywhere else, are to determine whether the people going there are totally healthy people or have underlying medical problems. I would not advise anyone with heart or lung disease to travel to areas with such high altitude. For healthy persons there is a medication that can be taken to help prevent harmful effects of the high altitude. That drug is called Acetazolamide (diamox). It is taken twice a day during the early days after arriving in the region of high altitude. This drug will require a prescription from a physician.

"The people who get SARS essentially are those taking care of patients in the hospital or family members of active cases. The risk to travelers is very small, even during an epidemic."

I have a chance to travel to Hong Kong and mainland China. Do I still have to be concerned about SARS?

Currently SARS is not a problem anywhere in the world. Even when SARS is at its peak it is really not a risk for travelers. The people who get SARS essentially are those taking care of patients in the hospital or family members of active cases. The risk to travelers is very small, even during an epidemic, and Southeast Asia right now appears to be entirely safe, without SARS cases occurring.

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