TRAVELLERS' DIARRHEA

Illness

Travellers' diarrhea is caused by bacterial, parasitic or viral infection. Altitued, fatigue, jet lag and a changed diet do not seem to be responsible for symptoms.

The diagnosis of travellers' diarrhea is to be considered after the passage of 3 loose stools over a period of 24 hours, often accompanied by nausea, vomiting, cramps and abdominal pain, sometimes blood in the stolls. The sickness usually lasts 3 to 5 days.

A person is infected through contaminated or poorly stored water; rarely through human contact.

Prevention

Poorly cooked, unpeeled, unwrapped food presented on buffets or by street vendors in hot countries are at the greatest risk of transmitting travellers' diarrhea. They must be avoided.

Taking an antibiotic as a preventative measure is not recommended because of the risk of sometimes serious side-effects, of the development of antibiotic resistant bacteria, and because of a false sense of security that such practice engenders in the traveller. Physicians may prescribe bismuth subsalicylate to certain travellers because of immunosuppression through pre-existing disease such as inflammatory bowel disease.

Treatment

Réhydratation

Replacement of fluids lost through diarrhea is essential. This is the first and sometimes the only measure necessary. Safe or treated water is adequate. A useful rehydration solution: 1 litre of water, 8 level tsp of sugar, 1 level tsp of salt and 1 squeezed lemon or orange for taste.

Diet

Foods rich in gluten and fibre (pasta, lentils, potatoes, rice, etc.) do not favour continued diarrhea and are thus recommended. Dairy products should be avoided.

Antiperistaltics

Antiperistaltic agents like loperamide or diphenoxylate chlorhydrate should be used with caution in order to slow the intestine when necessary, as when travelling by public transport, since they also slow the excretion of the infectious agent and can sometimes cause complications (such as toxic megacolon). They are contraindicated in the presence of high fever or blood in the stools.

Antibiotic

Antibiotics decrease the duration of an episode of travellers' diarrhea as well as associated symptoms. Quinolones are the current first choice of treatment. There is no need to add an antiperistaltic when taking a quinolone. Your physician at the Centre de Santé-Voyage will prescribe you the right medication at the right dose. The antibiotic should be used if the diarrhea is severe, more than 8 episodes in 24 hours, without fever or blood in the stools.

It is nevertheless not always necessary to take antibiotics with you on your trip. However, for trips off the beaten track, to places far from convenient medical treatment, or for travellers with AIDS, immunosuppression, diabetes or inflammatory bowel disease, it is prudent to have an antibiotic on hand for self-treatment.

It is preferable to consult a health professional if there is blood in the stools, or in the presence of persistent fever.

© Centre santé-voyage de Québec, 1997