International Medical Services

Traveller’s Diarrhea

Traveller’s Diarrhea (TD) is the most common travel-related illness. Most often it is caused by bacteria and resolves without treatment in four to five days.

Prevention

Food preparation

• Food should be selected with care, the safest being well-cooked meals served hot.
  • Raw meat, unpasteurized dairy products, puddings, and salads frequently harbour harmful bacteria and parasites.
• Eat only fruit and vegetables that you have washed with safe water and peeled yourself.
• Avoid street vendors and leftovers.

Water purification

• Contaminated water is a major source of pathogens and must be considered unsafe where sewage disposal and water purification systems are limited.
  • First-class hotels are not a guarantee of adequate water purification.
• Avoid ice cubes.
• Bottled drinks, carbonated beverages, tea and coffee are usually safe.
  • Water for brushing teeth should be from a purified source or from the hot water tap.

Purify Your Water

• Bring it to a boil; or
• Strain it through a coffee filter, add five drops of 2% Tincture of Iodine or four drops of 4% chlorine bleach per litre. Allow to stand for 30 minutes.
• Use portable water filters
  • Aquamira: www.aquamira.com
  • Hydro-Photon: www.hydro-photon.com/
  • MSR: www.msrcorp.com
  • Katadyn (Europe only): www.katadyn.com

Treatment

1. Maintain Hydration

Appropriate oral rehydration solutions include:

• WHO electrolye/glucose mixture
• Gastrolyte
• Homemade rehydration solution

Making homemade rehydration solutions

Glass 1

Add 1/2 tsp. corn syrup or honey + pinch of salt to an 8 oz. (approx. 235 mL) glass of organe or apple juice

Glass 2

Add 1/4 tsp. baking soda to an 8 oz. (approx. 235 mL) glass of purified water.

Drink alternately until thirst is quenched supplement as desired with a carbonated beverage. Nursing infants should continue breastfeeding.

2. Symptom Control (Antimotility Agents)

Loperamide (Imodium) is helpful to control symptoms. It should be used in conjunction with the first dose of antibiotic, and sparingly as needed thereafter. Most recommend that it should not be used if bloody diarrhoea is present.

Pepto-bismal is helpful for both prevention and treatment.

3. Antibiotics

1. Prevention (high risk travellers): The use of preventive antibiotics is generally discouraged though can be considered for periods less than 3 weeks for travellers with:
   • A poor “track-record”
   • Underlying medical problems – diabetes mellitus, kidney disease, chronic stomach or bowel conditions, low gastric acid and persons with depressed immunity (AIDS/cancer treatment).
2. Self treatment:
   • For persons who develop moderate to severe diarrhoea the recommended drugs and treatment schedules are as follows:

     Drug	Adult Dose	Pediatric Dose
     Ciprofloxacin (cipro)	500 mg 2x/day as needed (up to 3 days)	20-30 mg/kg every 12 h (up to 3 days); max dose 500 mg
     Ofloxacin	200 mg 2x/day as needed (up to 3 days)	7.5 mg/kg every 12 h (up to 3 days); max dose 200 mg
     Levofloxacin	500 mg daily as needed (up to 3 days)	10 mg/kg daily (up to 3 days); max dose 500 mg
     Azithromycin	1000 mg single dose	10 mg/kg single dose

3. Professional Care

If abdominal pain or diarrhoea persist longer than two days or worsen, seek professional care.

For more information:

Public Health Agency of Canada:
www.phac-aspc.gc.ca/tmp-pmv/info/diarrhea-eng.php

World Health Organization:
www.who.int/topics/diarrhoea/en/