Diarrhea (Traveler’s)

What is it?

This is a diarrheal illness linked to traveling to resource-poor parts of the world. This is a common problem, 40-60% of people who travel to these regions develop diarrhea. The concern is real, but the diarrhea itself is usually self-limited. Dehydration is possible. The diarrhea may develop even after returning home; typically within 10 days.

Why does it happen?

The diarrhea may be due to bacteria, viruses, or parasitic organisms, and typically is from eating or drinking contaminated food or water. Bacterial illnesses are the most common. The diarrhea is related to the organism being eaten and reaching the intestines.

What are the symptoms?

Typically, the diarrhea develops within 4-14 days of arrival in the new area. The diarrhea usually resolves on its own and lasts for one to five days. Some people have symptoms for a longer period of time.

The symptoms depend on the cause of the diarrhea. There may be:

Malaise
Lack of appetite
Abdominal cramps
Nausea
Vomiting
Low-grade fever

How is it diagnosed?

Often it is diagnosed just based on your symptoms. Rarely, stool cultures are sent unless you have a fever, pain with passing a bowel movement, urgency, cramping, or bloody diarrhea. If you have mainly symptoms of the upper GI tract such as bloating, gas and nausea, stool studies will be examined for Giardia and Cyclospora. Based on where you traveled, the stool may be examined for specific parasites.

How is it treated?

Typically, if symptoms last longer than 2-3 days you will be treated. There are three main interventions:

Fluid replacement

This is the most important treatment.

If your diarrhea is mild, passing 1-2 unformed stools in a day without other symptoms
Drinking fluid with both salt and sugar (broth, fruit juice, or similar) is necessary

If your diarrhea is severe, use an oral rehydration solution to replace the electrolytes in the appropriate concentrations.

You can purchase an oral rehydration solution that is mixed with drinking water.
You can make this at home by following the recipe below:
- 1/2 teaspoon salt
- 1/2 teaspoon baking soda
- 4 tablespoons of sugar
- 1 liter of water
The electrolyte concentration used for exercise and sweat replacement (Gatorade, Powerade, etc.) is not with the same electrolyte levels.

Diet

There is no one diet that has been studied and shown to be the best. Even so, dietary restrictions are often suggested starting with eating only clear liquids.

Antibiotics

Treatment with medications to kill bacteria is valid if you are having diarrhea with more than four unformed stools daily with or without fever, blood, pus, or mucus in the stool.

Ciprofloxacin, 500mg twice daily for 1-3 days is often started. This typically causes symptoms to go away within one day.
Azithromycin, 1000mg once, especially if traveling in Southeast Asia as some of the bacteria there seems to not be affected by ciprofloxacin.

Antimotility agents

These are medicines used to slow down the diarrhea such as loperamide or diphenoxylate. They do not treat the cause and should only be given with antibiotics.

What can I do?

Before your next trip to an underdeveloped country, you can ask your health care professional for a prescription for medicine that you can take along. If you develop diarrhea on this trip, you can then take the antibiotic.