• Traveler's Diarrhea: Don't Let It Ruin Your Vacation

    IMAGE Robin considered herself a seasoned traveler. She'd been south of the border before, so when she visited a friend in Mexico City, she knew better than to drink the water. But she let her guard down at a dance club in Acapulco and had a drink with ice. She spent the next seven hours on a bus battling traveler's diarrhea (TD). "The discomfort was excruciating," Robin adds.
    Traveler's diarrhea is one the most common illnesses affecting travelers. Travelers who ingest contaminated food or drink may experience a range of symptoms, including watery diarrhea, nausea, vomiting, fever, and abdominal pain, that can last for 3-7 days.

    Deciding on a Location

    Visitors to developing countries, like Latin America, Africa, and the Middle East, put themselves at increased risk of TD, according to the US Centers for Disease Control and Prevention (CDC). TD goes hand in hand with poor sanitation and poor refrigeration. When you travel, use your common sense when determining where and what to eat while abroad. For example, five-star hotels that cater to world travelers are generally safer bets than open-air markets. To avoid problems, don't eat at a street corner vendor or a festival.

    Having a Prevention Plan

    For travelers who do not want to limit their destinations, a healthy dose of awareness can lower their risk of TD. Here are some tips when visiting high-risk locations:
    • Do not drink tap water or add ice cubes. Drink only bottled water. Bottled carbonated beverages, steaming hot tea or coffee, wine, and beer are typically okay to drink.
    • If necessary, boiling for 10 minutes, or using iodine or cholorine tablets will disinfect tap water.
    • Brush your teeth using bottled, boiled, or iodine-treated water only.
    • Avoid raw foods, especially salads and fruits, unless you can peel them yourself.
    • Avoid cooked food that has been sitting out in the open, even if it is re-heated. Food still hot from an oven is generally safer.
    • Feed children six months and younger breast milk or formula prepared with sterilized water.
    • Avoid seafood from tropical reefs, some of which can be toxic even after cooking.
    In general, you should avoid these foods:
    • Foods that are not steaming hot
    • Unpasteurized dairy products
    • Cold sauces and toppings
    • Open buffets
    • Undercooked or incompletely reheated foods
    • Fruit juices
    It is a good idea to see your doctor to get antibiotics and/or anti-diarrheal medications before you go.

    Getting Treatment Right Away

    What if you do get sick? At the first sign of diarrhea, start with a two- to three-day course of antibiotics if you got them from the doctor. Start taking anti-diarrheal medications as needed for more immediate relief.
    Avoid giving anti-diarrheal medicine to young children, though. Young children with diarrhea should see a doctor early on because they are at a higher risk for dehydration than adults. For mild to moderate diarrhea in children, make sure your child is staying hydrated. If diarrhea is severe (10 or more watery stools per day) or the child is urinating less frequently (a sign of dehydration), get medical care right away.
    Staying hydrated is an essential part of treatment for adults, as well. You replenish fluid balance better with oral rehydration salts (ORS). They can be purchased before your trip and packed in your toiletry kit or are available in most travel locations. You will have to mix the ORS with a safe water source.

    Knowing When to Get Help

    Seek immediate medical care for TD in any of the following situations:
    • Vomiting or diarrhea does not go away after a couple of days
    • Symptoms do not subside after 3-7 days and/or after antibiotic treatment
    • Lightheadedness
    • Worsening pain
    • High fever and/or disorientation
    • Stools are bloody and/or contain mucus
    • Signs of dehydration, such as decreased saliva or urination
    • Rapid, irregular heartbeat; chest pain
    • You are pregnant or caring for a young child who develops diarrhea
    In some cases, TD can persist despite antibiotic treatment. Rarely, it can trigger other gastrointestinal problems. See your doctor if symptoms worsen or do not resolve.


    The International Society of Travel Medicine http://www.istm.org

    Traveler's HealthCenters for Disease Control and Prevention http://wwwnc.cdc.gov


    Public Health Agency of Canada http://www.phac-aspc.gc.ca

    Travel Canada http://travel.gc.ca


    Food and water safety. http://wwwnc.cdc.gov/travel/page/food-water-safety. Updated April 21, 2013. Accessed November 21, 2013.

    Traveler's diarrhea. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated October 8, 2013. Accessed November 21, 2013.

    Traveler's diarrhea. Centers for Disease Control and Prevention website. Available at: http://wwwnc.cdc.gov/travel/page/travelers-diarrhea. Updated April 26, 2013. Accessed November 21, 2013.

    Water disinfection. Centers for Disease Control and Prevention website. Available at: http://wwwnc.cdc.gov/travel/page/water-disinfection. Updated April 26, 2013. Accessed November 21, 2013.

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