Travelers' Diarrhea - Treatments

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How is travelers' diarrhea treated?

Although prophylactic antibiotics (antibiotics taken before the person is exposed to the pathogen) are effective in preventing travelers' diarrhea, they generally are not recommended. The side effects of antibiotics, including photosensitivity (sensitivity to the sun that results in injury to the skin) and diarrhea can be major problems. Antibiotic prophylaxis can be considered in individuals with underlying medical diseases in whom diarrhea is more likely to occur or who may be profoundly affected by the diarrhea. This group includes people with previous stomach surgery, active inflammatory bowel disease, underlying immunodeficiency conditions, and other serious medical disorders. In these situations drugs of the quinolone class (ciprofloxacin [Cipro, Cipro XR, Proquin XR], levofloxacin [Levaquin]) have been shown to be effective.

Bismuth subsalicylate (Pepto-Bismol) in liquid or pill form also has been shown to be effective in preventing diarrhea in up to 65% of travelers although Pepto-Bismol may cause black stools and, rarely, ringing in the ears. People allergic to aspirin should avoid Pepto-Bismol.

When treating afflicted individuals, drugs that alleviate symptoms as well as antibiotics play a role. With moderate symptoms, the addition of Pepto-Bismol alone may suffice. Alternatively, anti-diarrheal agents such as diphenoxylate and atropine (Lomotil) or loperamide (Imodium) can be given. With severe disease, characterized by frequent diarrhea or dehydration, or complicated by the passage of bloody stools, Lomotil or Imodium should not be used and you should consult your doctor.

Oral fluids are a mainstay of therapy since they are important to prevent dehydration. Tips for staying hydrated are:

  • Small, frequent sips of clear liquids (those you can see through) are the best way to stay hydrated.
  • Avoid alcoholic, caffeinated, or sugary drinks, if possible. Over-the-counter rehydration products made for children such as Pedialyte and Rehydralyte are expensive but good to use if available.
  • Sports drinks such as Gatorade and PowerAde are fine for adults if they are diluted with water because at full strength they contain too much sugar, which can worsen diarrhea.
  • Try to drink at least as much or more fluid than you think is coming out or lost with the watery diarrhea.
  • For mild to moderate dehydration, oral rehydration salts (ORS) may be recommended. These are available in pharmacies in most developing countries. Severe hydration usually requires emergent intravenous rehydration (IV).
  • If the affected individual cannot hold down fluids, or is losing fluids faster than they can take them in, seek medical care immediately, because some patients will require IV hydration.

Children and the elderly are more susceptible to dehydration. If a person feels light-headed or woozy, feels a rapid pulse or their mouth and lips are dry, they should consult a physician. If a child is listless, not eating or drinking and does not make wet diapers or urinate within a few hours they also should be seen quickly by a doctor.

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Comment from: Sara, 55-64 Female (Patient) Published: January 25

Treatment depends upon where you are when the diarrhea starts. If you have to travel then you have to take Imodium or Cipro, if you have it, so that you can move on. If you're already home, or if you are somewhere you can stay put for 3 or 4 days then the best thing is to let the diarrhea happen; don't try to stop it. After each trip to the bathroom try to drink as much water as you just lost. When I'm at home and know my tap water is safe I like to drink lukewarm instead of cold water because the lukewarm water doesn't cause as much cramping. I guess that caffeine isn't good but a little warm tea makes me feel better. Eat clear broth, Jello, tea. When you get so hungry you need something else move on to rice, bananas, applesauce, and plain toast.

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