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Treating Traveler’s Diarrhea- Bugs and Bowels

Traveler’s diarrhea can be really miserable when people are far from home. Despite following food and water precautions, there is still a good chance of contracting it especially in low resource countries, and popular destinations like Mexico and the Caribbean. It doesn’t matter whether if your traveler is staying in a 5- star resort or a hostel. The water comes from the same source. 

In most cases, travelers' diarrhea clears up on its own within  a day or two. The majority of cases resolve within a week. 

There has been much debate about the best way to treat traveler’s diarrhea and to still be good stewards of antibiotic use. In the US, we rarely treat diarrhea with antibiotics because most diarrhea is viral in origin. In low resource countries, most diarrhea is bacterial, so there is a role for treatment with antibiotics.

What can you recommend for mild diarrhea?

According to the International Society of Travel Medicine’s evidence based report, mild symptoms can be well managed with bismuth subsalicylate (Pepto Bismol tablets). Patients who should not take salicylates should not use this product but use an antimotility agent, loperamide, instead. Loperamide can be used judiciously to reduce the number of bowel movements but not to stop them completely.

Use of probiotics or bovine colostrum is not recommended by the FDA because of the lack of data for effectiveness for both prevention and treatment.

What if it’s worse than that?

If your traveler is having significant diarrhea, advise one azithromycin 500 mg tablet. Most people will feel much better after one dose.  If so, they can stop there. If symptoms persist, they can take one daily for a total of 3 days. Ciprofloxin is not used routinely now due to black box warnings and due to increasing worldwide bacterial resistance to it. Be sure to write on the prescription PRN for traveler’s diarrhea so if the traveler will know what it is and what it is used for.

Hydration

Staying hydrated is very important, especially in a hot, humid climates. There are formulas for adult oral rehydration in packets and effervescent tablets, such as Hydralyte, which is very palatable.

Educate your traveler to seek medical care if they have severe abdominal pain, fever, vomiting or have blood in their stools.

I advise travelers to bring, Pepto Bismol tablets, loperamide, a prescription for azithromycin, Hydralyte and a thermometer to be prepared to treat traveler’s diarrhea.

Want to learn more?  Check out Preventing Traveler’s Diarrhea  and the Comprehensive Course in Travel Health.

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