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Travelers Diarrhea
Acute diarrhea affects millions of travelers each year and, as most of you know, it's no holiday.

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During the summer I heard from a number of patients who went on vacation and were affected by travelers diarrhea.  Acute diarrhea affects millions of people traveling to developing countries each year.  People get travelers diarrhea by eating food and drinking water that contain germs. People can get this illness in areas of the world where drinking water is not clean.  Unsafe foods and drinks include salads, unpeeled fruits, raw or poorly cooked meats and seafood, and tap water. 


Travelers diarrhea is usually three or more unformed stools in 24 hours with at least one of the following: fever, nausea, vomiting, abdominal cramps, or bloody stools.   Most cases occur within the first two weeks of travel and can last four days without treatment.


One’s risk of developing travelers diarrhea depends on the destination of travel.   Africa, South Asia, Latin America, and the Middle East are common are regions with the highest risk of infection. 


Travelers diarrhea is caused mainly by bacteria.  Prevention of this bacterial infection through dietary precautions is important.  Travelers are often advised to “boil it, cook it, peel it, or forget it.”  Antibiotic prophylaxis is not recommended by the Centers for Disease Control and Prevention (CDC) because it can lead to drug resistant organisms.  However people with certain health conditions (kidney disease, cancer, diabetes, AIDS or an illness that affects the digestive system) might be candidates.

Pepto bismol provides a rate of protection of around 60% against traveler’s diarrhea.  Several studies show that bismuth subsalicylate taken as either 2 tablets 4 times daily or 2 fluid ounces 4 times daily reduces the incidence of travelers' diarrhea. Use of bismuth subsalicylate should be avoided by persons who are allergic to aspirin, during pregnancy, and by persons taking certain other medications (e.g., anticoagulants, probenecid, or methotrexate). In addition, persons should be informed about potential side effects, in particular about temporary blackening of the tongue and stool, and rarely ringing in the ears.  Probiotics like lactobacillus GG have suggested protection rates up to 47%. These “friendly” bacteria colonize the intestinal tract and in theory prevent the “bad” bacteria form infecting the gut.


Travelers diarrhea usually is a self-limited disorder and often resolves without specific treatment; however, oral rehydration is often beneficial to replace lost fluids and electrolytes. Clear liquids are routinely recommended for adults. Travelers who develop three or more loose stools in an 8-hour period---especially if associated with nausea, vomiting, abdominal cramps, fever, or blood in stools---may benefit from antibiotics. Antibiotics usually are given for 3-5 days. Commonly prescribed regimens are 500 mg of ciprofloxacin twice a day or 400 mg of norfloxacin twice a day for 3-5 days.  The use of Immodium or lomotil should be used with caution. 

Potential travelers should consult with a doctor or a travel medicine specialist before departing on a trip abroad. Information about TD is available from your local or state health departments of the World Health Organization(WHO).  Other information that may be of interest to travelers can be found at the CDC Travelers' Health homepage at www.cdc.gov/travel.

Here are some quick tips that should help you in your travels:



  • Do not drink tap water and do not use it to brush your teeth.
  • Do not drink bottled water if the seal on the bottle has been broken.
  • Do not use ice that has been made from tap water.
  • Do not drink milk or eat dairy products that have not been pasteurized (heated to a temperature where all germs are killed).
  • Do not eat raw fruits or vegetables unless they can be peeled and you are the one who peels them.
  • Do not eat lettuce and other leafy raw vegetables (like spinach), and do not eat cut-up fruit salad.
  • Do not eat raw or rare (slightly cooked) meat or fish.
  • Do not eat food from people who sell food on the street.



  • Soft drinks that are carbonated (drinks with a gas called carbon dioxide in them).
  • Hot drinks, such as tea or coffee.
  • Carbonated or noncarbonated bottled water as long as you are the one who breaks the seal on the bottle.
  • Raw fruits or vegetables that can be peeled, as long as you are the one who peels them.
  • Food that is served hot.
  • Meat that is well cooked.


Please stay well and, as always, warmest regards...




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Andrea Ruman, M.D. - Doctor of Internal Medicine
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Dr. Andrea Ruman: Female medical doctor, physician, internist for Marina Del Rey, Santa Monica, West Los Angeles (LA), and Culver City in California. Specialties include women's health (including physical examinations, pelvic exams and pap smears), weight loss support and preventive medicine.