Traveler's Diarrhea (cont.)

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What are the symptoms of travelers' diarrhea?

The symptoms of travelers' diarrhea vary. Generally, diarrhea occurs within the first week of travel and lasts up to three to four days. Affected individuals on average pass up to five loose or watery bowel movements per day which may be associated with cramps. On occasion, individuals may experience fever or bloody stools. The diarrhea may be accompanied by abdominal pain and cramping, bloating, or increase in stomach or intestinal noises or gurgling (borborygmi).

How is travelers' diarrhea diagnosed?

The presumptive 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. Identification of the pathogen results in the definitive diagnosis.

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.

Medically Reviewed by a Doctor on 5/9/2014

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