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Traveller's Diarrhea

Topic Overview

What is traveller's diarrhea?

Traveller's diarrhea is a common medical problem for people travelling from developed, industrialized countries to developing areas of the world.

High-risk areas for traveller's diarrhea include developing countries in Africa, Asia, the Middle East, and Latin America. Low-risk areas include the developed countries of North America, Central Europe, Australia, and Japan.

What causes traveller's diarrhea?

Traveller's diarrhea is usually caused by a bacterial infection. Bacteria such as Escherichia coli (E. coli), Campylobacter, Shigella, or Salmonella are the most common causes. These bacteria are in water contaminated by human or animal stools. Drinking water, water used to wash food, or irrigation water may be affected. When the traveller drinks this water or eats contaminated food, he or she is likely to get diarrhea.

Common sources of bacteria that cause diarrhea are undercooked or raw foods, contaminated food, or contaminated water (including ice cubes).

What are the symptoms of traveller's diarrhea?

Traveller's diarrhea can be mild to severe. Most people who develop traveller's diarrhea have symptoms within the first 2 weeks, and often within 3 to 4 days, of arriving in a developing area. Symptoms include:

  • Diarrhea.
  • Abdominal cramps.
  • Mild to severe dehydration.
  • Low energy, nausea, and vomiting.
  • Fever, vomiting, and stools with blood or mucus. These symptoms mean you have serious diarrhea, which is more likely to lead to problems with dehydration. Dehydration may change how some medicines work, such as birth control pills or medicine for malaria.

How is traveller's diarrhea treated?

Treatment for traveller's diarrhea includes drinking fluids so you don't get dehydrated, taking non-prescription medicines, and sometimes antibiotics and intravenous (IV) fluids.

  • Take small sips of bottled or boiled water or a rehydration drink often and small bites of salty crackers.
  • If possible, drink a solution made with World Health Organization (WHO) oral rehydration salts. Packets of the salts are available at stores and pharmacies in most developing countries. Add one packet to boiled or treated water, making sure to read the instructions for how much of the salts and water to use. Drink the solution within 12 hours if kept at room temperature, or within 24 hours if you keep it in the fridge.
  • Begin eating a simple diet of bland foods, such as crackers, rice, bread, potatoes, or bananas, which usually will help slow diarrhea. After your diarrhea is gone, you may eat a regular diet again.

Children 2 years old or younger are at high risk of dehydration from diarrhea. If your child has diarrhea:

  • Give your child a solution of WHO rehydration salts and keep giving them their regular food as long as diarrhea continues. If your baby has trouble keeping the liquids down, try giving sips by spoon often. It's important that the rehydration salts be added to bottled water or water that has been boiled.
  • Continue breastfeeding normally. Bottle-fed babies should continue their usual formula.
  • Feed your child starches, cereals, yogurt, fruits, and vegetables.
  • Seek medical help immediately if you or your child has bloody diarrhea, fever, or persistent vomiting, and give rehydration fluids in the meantime.

Non-prescription medicines

Non-prescription medicines may help treat diarrhea. Use non-prescription antidiarrheal medicine if you do not have other signs of illness, such as fever, abdominal cramping or discomfort, or bloody stools. If you have fever, bloody stools, or vomiting, antibiotics may be needed.

Bismuth subsalicylate, or BSS (such as Pepto-Bismol or Kaopectate), has been shown to be effective in preventing and treating traveller's diarrhea.

Non-prescription medicines to slow diarrhea, such as loperamide (for example, Imodium), may be used to treat diarrhea but should not be used to prevent traveller's diarrhea because they can cause constipation.

Talk to a travel health professional about traveller’s diarrhea

Talk to a travel health professional about traveller’s diarrhea before your trip. They will tell you about treatment options, including antibiotics. Knowing your options is especially important if you:

  • Have medical problems.
  • Take prescription medicines that may not work properly when you have diarrhea.
  • Are travelling with children.

Can I prevent traveller's diarrhea?

The best way to lower your risk of traveller's diarrhea is to avoid food or water that may be contaminated. A good rule of thumb for food safety is, "If it's not boiled, well-cooked, or peeled, don't eat it."

Avoid drinking local water where you're travelling. Drinks that are usually safe include:

  • Tea and coffee if made with boiled water.
  • Carbonated bottled water or soda pop.
  • Bottled beer and wine.
  • Bottled water (make sure bottle is sealed).

Water can be boiled, treated, or filtered to make it safe to drink. Talk to your travel health professional about the best options for your trip.

Also, be aware that contaminated water may be used to wash fruits and vegetables, clean utensils and plates, and make ice cubes. Brushing your teeth with untreated water also may increase your risk of infection.

Foods and drinks to avoid:

  • Any raw or undercooked meat, fish, or seafood.
  • Salads or other foods served at room temperature.
  • Drinks served with or made with ice.
  • Unpasteurized fruit juices and dairy products.
  • Foods from street vendors.

Good handwashing is important in preventing the spread of infectious diseases. Washing with treated water or using alcohol wipes or antibacterial gels to disinfect your hands are good ways to lower your risk of getting an infectious disease.

Talk with your doctor or travel health professional about antibiotics you can carry with you on your trip and instructions on when to use them just in case you get diarrhea.

Dukoral vaccine is a cholera vaccine. There is little proof that it helps prevent traveller's diarrhea, so it is usually not recommended for travellers.

Other information sources

Credits

Adaptation Date: 7/16/2019

Adapted By: Alberta Health Services

Adaptation Reviewed By: Alberta Health Services

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