Travelers’ Diarrhea

SafeGard Travel Medicine physicians routinely recommend travelers’ diarrhea medications for all international travelers. Unless contraindicated, we generally recommend Azithromycin rather than Ciprofloxacin for various reasons. The travel pharmacies we work with provide these medications when recommended.

What is travelers’ diarrhea?

Travelers’ diarrhea (TD) is the most common travel-related illness (30% to 70% of travelers depending on the destination and season of travel). TD is a clinical syndrome that can result from a variety of intestinal pathogens: bacterial, viral and protozoal. Bacterial and viral TD present with the sudden onset of bothersome symptoms that can range from mild cramps and urgent loose stools to severe abdominal pain, fever, vomiting, and bloody diarrhea, generally lasting 3-7 days or 2-3 days respectively. Protozoal diarrhea generally has a more gradual onset of low-grade symptoms, with 2-5 loose stools per day and can persist for weeks or months untreated. An acute bout of gastroenteritis can lead to persistent gastrointestinal symptoms, even in the absence of continued infection.

How can I prevent travelers’ diarrhea?

Traditionally, it was thought that TD could be prevented by following “boil it, cook it, peel it, or forget it.” However, studies show that people who follow these rules may still become ill. The primary source of risk for TD is likely poor hygiene practices in local restaurants. The following approaches should reduce, but never completely eliminate,the risk for TD. These include:

• Follow good food and water practices.
• Use appropriate over-the-counter anti-diarrheal agents
• Use appropriate antibiotics
• Practice good hand washing with soap where available
• Have small containers of alcohol-based hand sanitizers (containing at least 60% alcohol) to clean hands before eating when handwashing is not possible.

Although there are vaccines for Cholera, Hepatitis A, and Typhoid Fever, there are no vaccines available for most pathogens that cause TD.

Who should get medications?

There is a risk of travelers’ diarrhea in all countries, but there is an increased risk in countries with inadequate electrical, water and/or sanitation services. Temperate climates may show a seasonal variation with higher rates of TD during warmer months. Since travelers may experience more than a single episode on a single trip, our physicians provide medications for multiple bouts of TD for longer trips.