Medical Services
Travel Medicine/Preparation

Traveler's Diarrhea

USE THE PEACE CORPS RULE - Boil it, cook it, peel it or forget it.

Eating Abroad

• Hot and steaming is safe.
• Bread is safe.
• Rice and noodles are safe if cooked and steaming hot.
• Fruit is safe if freshly peeled by the consumer.
• Sealed bottled water is safe.
• Sealed carbonated drinks are safe.

Prevention -- AVOID

• Buffets
• Room-temperature foods
• Previously peeled fruit, raw produce, and salads
• Raw or poorly-cooked seafood
• Water or ice may not be safe, even for brushing teeth
• Unboiled tapwater
• Beverages not in factory-sealed containers
• Ice cubes unless made with safe water
• Milk products unless boiled or pasteurized

Traveler's diarrhea is the tourist's most common complaint everywhere in the world. All travel involves a risk of acquiring diarrhea. Certain areas are very high risk; as high as 50 percent. The best defense is to develop safe eating and drinking habits when in high-risk areas.

Various seafood poisons have similar symptoms to Traveler's Diarrhea. Whenever you exhibit symptoms, you need to get a careful dietary history. Learn more about dealing with seafood poisoning and toxins.

Ways to Avoid It
You can avoid most cases of traveler's diarrhea by eating food that is steaming hot (not merely cooked), has a high acid content (like citrus), a high sugar content (jellies and syrups), or one that is dry (bread).

Anything that is moist and warm, or at room temperature, is unsafe. This includes sauces, salads and anything on a buffet. Citrus fruits and any fruit you peel are safe. Your hands must be clean, however. Unpeelable fruits like grapes and berries are not safe. An unpeeled tomato is not safe, but a tomato peeled by the consumer is safe. Watermelon is sometimes injected with water to make it heavier and therefore may be unsafe.

Untreated water is not safe, but bottled drinks, wine and beer are. Bottled water must have an intact seal at the time of purchase to be considered safe. Children sometimes refill water bottles at a town well and resell them as safe water to unsuspecting tourists.

Medication -- Preventative
Sixty percent of travelers who do not take preventive medications in high-risk areas do not get diarrhea. Not taking a medication has many advantages. It is convenient, avoids drug side effects and costs nothing.

The CDC does not recommend travelers taking prophylactic antimicrobial agents to prevent diarrhea. However, bismuth subsalicylate (Pepto-Bismol®) has been shown to decrease the incidence of diarrhea when taken prophylactically in about 60 percent of cases (2 ounces four times daily or two tablets four times daily; it should not be used for longer than three weeks).

Pepto-Bismol is also useful in the treatment of diarrhea even if bloody diarrhea is present. The dosage (for diarrhea) is 1 ounce every 30 minutes, not to exceed 8 ounces in 24 hours. Don't take aspirin when taking Pepto-Bismol since salicylate toxicity may occur (salicylate is a component of both medicines). Wait at least two hours after taking antibiotics before taking Pepto-Bismol since it will retard antibiotic absorption.

Individuals allergic to, or intolerant of, aspirin who have any type of bleeding disorder; are taking an anticoagulant (blood thinner); who have a history of peptic ulcer; who have renal insufficiency, gout, or are taking probenecid or methotrexate, should avoid Pepto-Bismol. Don't give it to children under 3 years of age or children or adolescents with chicken pox or flu because of the risk of Reye's syndrome.

If symptoms do not improve within 48 hours, medical attention is recommended because of the possibility of a parasitic infection.

What to Take With You

• Pepto Bismol(r);
• antidiarrheal [Lomotil (diphenoxylate), Imodium (loperamide)];
• antibiotic prescribed by physician; and
• thermometer.

IF you have diarrhea and fever or bloody stool:

• take antibiotic only (Pepto-Bismol may also be used).

IF you have diarrhea without fever:

• take Pepto Bismol and/or antidiarrheal; and
• get medical attention if symptoms persist 48 hours.

Other Resources:

• Vaccinations and Immunizations
• Malaria Prophylaxis
• Behavioral Counseling