FAQ 1: What are the most common causes of travelers’ diarrhea?
The most common cause of travelers’ diarrhea is ingestion of food or beverages contaminated with pathogens. Most common agents of diarrhea are:
- coli, Campylobacter, norovirus (esp. cruise ships), rotavirus, Shigella, Salmonella
- Vibrio (esp. Southeast Asia)
- Entamoeba histolytica
FAQ 2: Who is at greatest risk of contracting travelers’ diarrhea?
- Adults of age less than 30 years and children of age less than 12 years.
- Immunosuppressed travelers (e.g., HIV with a low CD4 count.)
- Travelers taking acid-suppressive agents have risk for Campylobacter and Salmonella.
- Travelers to areas with substandard sanitation and hygiene in countries such as Africa, Central or South America, most of Asia, and the Middle East.
- Backpackers, travelers participating in adventure tours, and vacationers.
- Travelers with a history of repeated, severe travelers’ diarrhea.
FAQ 3: How can travelers’ diarrhea be prevented?
- Practice hand hygiene (e.g., washing, hand sanitizer with >60% alcohol)
- Drink only purified water and avoid under or uncooked food.
- Adults with severe condition can take bismuth subsalicylate 524 to 1048 mg four times each day (NNT = 4). Max duration three weeks.
- Various side effects of bismuth subsalicylateincludes black tongue or stool, nausea, constipation, and rarely tinnitus.
- Screen for interactions with other drugs.
FAQ 4: Can any natural products be recommended for prevention of travelers’ diarrhea?
You can rely on probiotics or bovine colostrum but there is insufficient evidence of relying on probiotics or bovine colostrum. If the patientis interested in trying a probiotic, Lactobacillus GG (e.g., Culturelle) and Saccharomyces boulardii (e.g., Florastor) have the best evidence.
FAQ 5: How is travelers’ diarrhea treated?
Diarrhea can be treated with antibiotics such as Cipro or Bactrim and hydration.
FAQ 6: Should patients take travelers’ diarrhea medicines with them?
Yes. They should pack them in their carry-on.
- Advise patients to take a copy of their antibiotic prescription with them, and leave a copy at home with a friend or relative.
- They should also take antibacterial hand wipes or an alcohol-based hand sanitizer containing at least 60% alcohol, and oral rehydration solution packets.
- Water purification tablets may be useful in certain circumstances.