Traveler's diarrhea

Traveler's diarrhea is a gastroenteritis that is usually caused by bacteria native to local water bodies. Symptoms of traveler's diarrhea include vomiting and diarrhea. Diagnosis is primarily clinical. Treatment for traveler's diarrhea includes ciprofloxacin, loperamide, and fluid replacement.

What causes traveler's diarrhea?

Traveler's diarrhea can be caused by bacteria, viruses, or parasites. However, the most common cause is enterotoxin-causing E. coli. E. coli is common in areas with poorly treated water supplies. The infection usually develops in people visiting developing countries. Travelers who avoid drinking local water may become infected by brushing their teeth with an improperly sanitized toothbrush, drinking iced drinks made from local water, or eating food treated with local water.

Symptoms of Traveler's Diarrhea

Nausea, vomiting, abdominal borborygmi, abdominal cramping, and diarrhea are the main symptoms of traveler's diarrhea, which develops 12 to 72 hours after consuming contaminated food or water. The severity of the disease varies. Some people develop fever and myalgia. Most cases are mild to moderate, although dehydration may occur, especially in warm climates.

Diagnosis of traveler's diarrhea

Typically, no specific investigations are required. However, in cases of fever, severe abdominal pain, and bloody diarrhea, a more serious illness should be suspected and appropriate investigations should be performed.

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Treating Traveler's Diarrhea

The mainstay of treatment for traveller's diarrhoea is fluid resuscitation and antimotility agents such as diphenoxylate or loperamide, with or without bismuth subsapicylate. Antimotility agents are contraindicated in patients with fever and bloody stools and in children under 2 years of age. Iodochlorhydroxyquine, which may be available in some developing countries, should not be used because it may cause neurologic dysfunction. Antibiotics are not indicated for mild diarrhoea. Antibiotics are given to patients with moderate to severe diarrhoea (> 3 loose stools in 8 hours), especially if vomiting, abdominal cramping, fever and bloody stools are present. Ciprofloxacin 500 mg orally twice daily for 3 days or levofloxacin 500 mg orally once daily is recommended. Children can be prescribed azithromycin 5-10 mg/kg orally once a day.

How to prevent traveler's diarrhea?

Traveler's diarrhea can be prevented by following these guidelines: Travelers are advised to dine at restaurants with a reputation for safety and to avoid food and drinks from street vendors. Only cooked foods that are still hot, fruits that can be peeled, and carbonated drinks in sealed bottles without ice (still drinks may contain tap water from unscrupulous vendors); raw vegetables should be avoided. Cafes and fast food restaurants pose an increased risk.

Antibiotic prophylaxis of traveller's diarrhoea is effective, but because of side effects and development of resistance, they should probably be reserved for immunocompromised patients.