Managing Traveler’s Diarrhea: Risks, Symptoms, and Prevention

March 22, 2024

Preventing Traveler’s Diarrhea: Proactive Measures for Safe Travel, Including Food and Water Safety, Hygiene Practices, and Avoiding Antibiotics as a Preventive Measure.

Traveler’s diarrhea is a common digestive disorder characterized by loose stools and stomach cramps. It is typically caused by consuming contaminated food or water. While generally not serious, it can be unpleasant for individuals traveling to regions with different climates and sanitary practices.

Risk Reduction and Treatment

To minimize the risk of traveler’s diarrhea, it is important to be cautious about food and beverage choices while traveling. Although the condition often resolves without treatment, it is advisable to carry doctor-approved medications when visiting high-risk areas to manage severe or persistent diarrhea.

Symptoms

Symptoms of traveler’s diarrhea may manifest suddenly during a trip or shortly after returning home. These symptoms include passing three or more watery stools per day, urgency to pass stool, stomach cramps, nausea, vomiting, and fever. In severe cases, dehydration, persistent vomiting, high fever, bloody stools, or severe abdominal or rectal pain may occur.

Seeking Medical Attention

While traveler’s diarrhea typically resolves within a few days, prolonged or severe symptoms may require medical attention, especially if caused by specific bacteria or parasites. Adults should consult a doctor if diarrhea persists beyond two days, if dehydration occurs, if severe pain or bloody stools are present, or if the fever exceeds 102 F. Similarly, parents should seek medical help for children experiencing persistent vomiting, high fever, bloody stools, signs of dehydration, unusual lethargy, or decreased urination.

Causes

Infectious agents such as bacteria, viruses, or parasites, commonly found in contaminated food or water, are the primary causes of traveler’s diarrhea. Additionally, stress from traveling or dietary changes may contribute to its onset. The discrepancy in susceptibility between travelers and natives of high-risk regions is often attributed to acquired immunity in the latter group.

Risk Factors

Popular tourist destinations in Central America, South America, Mexico, Africa, South Asia, Southeast Asia, Eastern Europe, South Africa, Central and East Asia, the Middle East, and certain Caribbean islands pose a higher risk of traveler’s diarrhea. Specific groups, including young adults, individuals with weakened immune systems, certain medical conditions, those taking acid blockers or antacids, and travelers during certain seasons, are at an increased risk of developing the condition.

Dehydration Risks

Traveler’s diarrhea can lead to dehydration due to the loss of essential fluids, salts, and minerals, particularly in hot weather. Dehydration poses a significant threat to children, older adults, and individuals with weakened immune systems, potentially resulting in organ damage, shock, or coma. Symptoms of dehydration include extreme thirst, very dry mouth, minimal urination, dizziness, and severe weakness.

Prevention

Food and Beverage Safety

To minimize the risk of contracting traveler’s diarrhea, it is advisable to adhere to the following guidelines:

Food Consumption

Avoid consuming food from street vendors, unpasteurized dairy products, raw or undercooked meat, fish, and shellfish, and moist foods at room temperature.
Opt for well-cooked and hot-served foods, and choose fruits and vegetables that can be peeled, such as bananas, oranges, and avocados. Avoid salads and unpeelable fruits like grapes and berries.
Be cautious that alcohol in drinks does not guarantee protection against contaminated water or ice.

Water Safety

Refrain from drinking unsterilized tap, well, or stream water in high-risk areas. Boil local water for three minutes, cool it naturally, and store it in a clean, covered container if consumption is necessary.
Avoid using locally made ice cubes or tap water-mixed fruit juices, and be wary of sliced fruits washed in contaminated water.
Prepare baby formula using bottled or boiled water, and opt for hot beverages like coffee or tea served steaming hot.
Consume canned or bottled drinks from unopened containers, ensuring they are wiped clean before consumption, and use bottled water for brushing teeth.
Avoid swimming in potentially contaminated water and keep your mouth closed while showering.

Water Purification

If access to bottled or boiled water is limited, consider carrying water-purifying equipment such as a microstrainer filter or chemical disinfectants like iodine or chlorine, following the recommended usage instructions.

Additional Measures

Ensure cleanliness and dryness of dishes and utensils before use, practice frequent handwashing, and utilize alcohol-based hand sanitizers if handwashing is not feasible.
Opt for food items requiring minimal handling, prevent children from putting dirty hands or objects in their mouths, and avoid infants from crawling on unclean surfaces.
Use visual cues like colored ribbons to remind against consuming tap water or using it for tooth brushing.

Other Preventive Measures

Antibiotics

Avoid taking antibiotics as a preventive measure for traveler’s diarrhea, as this can contribute to the development of antibiotic-resistant bacteria and may not protect against viruses and parasites.

Bismuth Subsalicylate

Consider using bismuth subsalicylate as a preventive measure, but under the guidance of a doctor, as it has been shown to reduce the likelihood of diarrhea. However, its usage should not exceed three weeks, and it should be avoided by pregnant individuals or those allergic to aspirin. Common side effects include harmless changes in tongue and stool color, constipation, nausea, and rarely, ringing in the ears.

By adhering to these preventive measures and being mindful of food and water safety, travelers can significantly reduce their risk of contracting traveler’s diarrhea.

Sources:

Mayo Clinic (2023). Traveler’s diarrhea. https://www.mayoclinic.org/diseases-conditions/travelers-diarrhea/symptoms-causes/syc-20352182. Accessed March 22, 2024

Johns Hopkins. Traveler’s Diarrhea. https://www.hopkinsmedicine.org/health/conditions-and-diseases/travelers-diarrhea. Accessed March 22, 2024