Traveler’s Diarrhea
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Traveler’s Diarrhea

(Montezuma’s Revenge; Turista)

Pronounced: Traveler’s die-ah-ree-ah

En Español (Spanish Version)

Definition

In persons traveling to international destinations, particularly in less developed countries, watery, loose stools ( diarrhea ) are most often caused by bacterial or viral infection. Most cases of traveler’s diarrhea resolve within 1 to 2 days without treatment and 90% resolve within one week. To ease symptoms, over-the-counter medications may be taken. If traveler’s diarrhea doesn’t resolve on its own in about a week, you may want to see your physician.

Causes

The primary cause of traveler’s diarrhea is ingestion of fecally-contaminated food or water. The offending substance carries a bacteria or virus that causes the diarrhea. The common pathogens include:

  • Bacteria
    • Escherichia coli
    • Campylobacter jejuni
    • Shigella
    • Salmonella
    • Yersinia
  • Viruses
    • Rotavirus
    • Norwalk virus
    • Enterovirus

Virus Attacking Cell

Virus

© 2008 Nucleus Medical Art, Inc.

Risk Factors

The most important risk factor for contracting traveler’s diarrhea is destination. Underdeveloped countries with contaminated water supplies pose the highest risk. The following factors increase your chance of developing traveler’s diarrhea. If you have any of these risk factors and plan to travel internationally, tell your doctor:

Inflammatory Bowel Disease

Crohn's Disease

© 2008 Nucleus Medical Art, Inc.

Symptoms

If you experience any of these symptoms do not assume it is due to traveler’s diarrhea. These symptoms may be caused by other health conditions:

  • Increased frequency and volume of stool
  • Frequent loose stools (4 to 5 watery bowel movements a day)
  • Abdominal cramping
  • Nausea
  • Vomiting
  • Fever
  • Bloating

Diagnosis

Your doctor will ask about your symptoms and medical history, and perform a physical exam. A stool sample will be taken.

Tests may include the following:

  • Stool culture to identify the pathogen

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Antimotility Agents

Loperamide (Imodium), diphenoxylate (Lomotil), and opiates reduce muscle spasms in the gastrointestinal tract, slowing transit time, thus increasing absorption. Infants and those with bloody diarrhea cannot use them. Bismuth subsalicylate (Pepto-Bismol) is an over-the-counter medication that decreases the frequency of stools. Note : This medication should not be used by children or pregnant women. It should not be used by people who have allergies to aspirin or salicylates. In addition, it should not be used by persons currently taking aspirin or similar type drugs (salicylates).

Antibiotics

Ciprofloxacin , norfloxacin , ofloxacin , doxycycline , or trimethoprim-sulfamethoxazole are the most common antibiotics for treating traveler’s diarrhea. These antibiotics are only effective for treating a bacterial infection.

Prevention

To help reduce your chances of getting traveler’s diarrhea, take the following steps:

  • Avoid eating foods from street vendors or unhygienic eating establishments.
  • Avoid raw or undercooked meat or seafood.
  • Eat foods that are fully cooked and served hot.
  • Avoid salads or unpeeled fruits. Have only fruits and vegetables that you peel yourself such as bananas or oranges.
  • Do not drink tap water or add ice cubes. Drink only bottled water or, if necessary, local water that you have boiled for 10 minutes or treated with iodine or chlorine. Bottled carbonated beverages, steaming hot tea or coffee, wine, and beer are all okay to drink.

RESOURCES:

American Academy of Family Physicians
http://www.aafp.org

American Gastroenterological Association
http://www.gastro.org

Centers for Disease Control and Prevention
http://www.cdc.gov

CANADIAN RESOURCES:

Canadian Partnership for Consumer Food Safety Education
http://www.canfightbac.org

Health Canada
http://www.hc-sc.gc.ca/index_e.html

References:

Guerrant RL, et al. Practice guidelines for the management of infectious diarrhea. Clinical Infectious Diseases . 2001:32:331-50.

Juckett G. Prevention and treatment of traveler’s diarrhea. Am Fam Physician . 1999;60:119-36.

Yates J. Traveler’s diarrhea. Am Fam Physician . 2005;71:2095-100, 2107-8.



Last reviewed January 2008 by David L. Horn, MD, FACP

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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