Traveler's Diarrhea (cont.)
How is travelers' diarrhea diagnosed?
The diagnosis of travelers' diarrhea is based solely on the
development of diarrhea when visiting a part of the world where this
condition is common among travelers. The diarrhea usually is mild,
self-limited, and resolves spontaneously. Symptoms usually can be
controlled with over-the-counter medications. (see below.) Only
when the diarrhea is severe or complicated, and possibly when
antibiotics are contemplated, should attempts be made to identify the
exact organism responsible for the diarrhea so that the correct drug
therapy can be selected. (Identification may be difficult or
impossible in undeveloped countries because of the lack of medical
laboratories.) When laboratories are available, the stool can be
examined for parasites and cultured for bacteria.
How is travelers' diarrhea treated?
Although prophylactic antibiotics 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 then you think is coming out with the diarrhea.
Children and the elderly are more susceptible to dehydration. If you feel light-headed or woozy, feel a rapid pulse or your mouth and lips are dry you 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 by a doctor.
Next: How can travelers' diarrhea be prevented? »
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