diarrhea, travelers'

travelers' diarrhea

Travelers' diarrhea ("turista") is defined as when someone from a developed area travels to Latin America, Asia, Africa, or the Middle East and begins having three or more unformed stools a day. It is caused by the ingestion in food or water of bacteria which in the final analysis can only come from one source: fecal contamination. About half the cases are due to toxin forming strains of E. coli.

Typically, this infection is not too severe and resolves by itself in three to five days, but some patients are sick longer than a week and may require medical attention. The greatest threat is to the very young, the very old, and the immunocompromised.

Prevention

Drink bottled water and beverages, avoiding ice and tap water (even for tooth brushing)
Avoid eating raw vegetables, salads, and unpeelable fruits
Eat only foods that are peelable, packaged, purified, or piping hot (the "rule of Ps")
Boil it, cook it, peel it, or forget it
Travelers' diarrhea can be avoided by chewing two 262-mg tablets of Pepto-Bismol® (bismuth subsalicylate) 4 times a day with meals
Use ready-to-feed formula or breast feedings for infants if possible; if using powdered formula, boil the water for formula preparation for at least five minutes rolling boil or use bottled water
If formula feeding, sterilize nipples and bottles by boiling before use

Treatment

Mild travelers' diarrhea will usually respond to an antimotility agent such as loperamide (Imodium A-D®); this should never be given if there is fever or blood in the stool. Do not use this product for travelers' diarrhea in children under school age without physician consultation. A physician should probably be consulted anyway for preschoolers and should definitely be consulted for children under two suffering from significant diarrhea.
Oral antibiotics are given for moderately severe cases; a single dose of ciprofloxacin (Cipro®) is often curative in 24 hours; a three day course of ciproflozacin or the similar norfloxacin may be required.
Antibiotic treatment should be avoided for mild cases.
Any time there is fever or blood in the stool, a physician should immediately be consulted.

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