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is a common medical problem for people traveling from developed, industrialized
countries to developing areas of the world. Traveler's diarrhea is sometimes
called by its more colorful names: Montezuma's revenge, Delhi belly, and Turkey
High-risk areas for traveler'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,
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 traveler 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).
Traveler's diarrhea can be mild to severe. Most people who develop
traveler's diarrhea experience symptoms within the first 2 weeks, and often
within 2 to 3 days, of arriving in a developing area. Symptoms include:
traveler's diarrhea includes drinking fluids to avoid dehydration, taking
nonprescription medicines, and in some cases, antibiotics and
intravenous (IV) fluids.
Children 2 years old or younger are at high risk of
dehydration from diarrhea. If your child has diarrhea:
Nonprescription medicines may help treat diarrhea. Use nonprescription
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.
subsalicylate, or BSS (such as Pepto-Bismol or Kaopectate), has been shown to
be effective in preventing and treating traveler's diarrhea. Bismuth
subsalicylates may reduce the effectiveness of medicines taken to prevent
malaria, should not be used for more than 3 weeks, and should not be taken by
those who can't take aspirin. They may cause you to have a black tongue or
black stools. The black color is usually not serious. Brushing your teeth and
tongue after taking a BSS may keep your tongue from turning black. If your
child or teen gets
flu, do not treat the symptoms with over-the-counter
medicines that contain bismuth subsalicylate or aspirin (such as Pepto-Bismol,
Kaopectate, or Alka-Seltzer). If your child has taken this kind of medicine and
he or she has changes in behavior with nausea and vomiting, call your doctor.
These symptoms could be an early sign of
Reye syndrome, a rare but serious illness.
Nonprescription medicines to slow diarrhea, such as loperamide (for
example, Imodium), may be used to treat diarrhea but should not be used to
prevent traveler's diarrhea because they can cause constipation.
If you have a high-risk medical condition such as diabetes or cancer, you
take prescription medicines that cause diarrhea, or you are traveling with a
child 11 years old or younger, seek advice from your doctor to
determine what medicines you may want to take on your trip. Be aware that
dehydration caused by diarrhea may alter the effectiveness of any medicines you
are taking for other medical conditions.
The best way to
prevent traveler'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." Raw seafood and milk products
usually are high-risk foods for bacterial contamination. Dry foods, such as
breads, or fruits that you can peel are safe to eat.
drinking local water where you are traveling. Beverages that are usually safe
to drink include:
Water also can be filtered or treated with iodine to make
it safe to drink.
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
Avoid eating food from street vendors where flies can
transmit bacteria and poor hygiene practices are more likely to contaminate
foods. If you purchase food at an outdoor market, make sure you boil it, cook
it thoroughly, or peel it before you eat it.
hand-washing 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 reduce your risk of getting an infectious disease.
with your doctor about antibiotics you can carry with you on your trip and
instructions on when to use them just in case you should develop
In the United States,
the Centers for Disease Control and Prevention (CDC) maintains current
information on infectious diseases around the world. Local health departments
can access this information to help you determine what prevention measures—such
as vaccines, antimalarial medicine, or supplies to treat water—are appropriate
for the area of the world you are traveling to. The CDC also offers a
Traveler's Health Hotline at (404) 332-4559. The CDC website
(wwwn.cdc.gov/travel/default.aspx) also updates information for travelers.
Resources for medical care in a foreign country
include embassies or consulates and major hotels. For English-speaking
travelers, multinational corporations or credit card companies also may have
referrals for local medical care in the foreign country.
March 27, 2013
E. Gregory Thompson, MD - Internal Medicine & W. David Colby IV, MSc, MD, FRCPC - Infectious Disease
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