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Traveller’s Diarrhea
What should I know about traveller’s diarrhea
(TD)?
 Diarrhea is the most common medical
problem affecting travelers to developing
countries.
 About 30-50% of travelers from
industrialized nations who travel to
underdeveloped countries get TD over a
1-2 week stay.
 TD usually begins suddenly and stops on
its own within 1-5 days (average 3 days).
 80-90% of cases of TD are caused by
bacteria.
Who is most at risk?
 Adventurous eaters.
 People with decreased stomach acid,
including those taking Losec, Nexium,
Pariet, Prevacid, or Tecta.
 Those with underlying medical problems
(e.g. cancer, inflammatory bowel
disease, immunocompromised AIDS).
 Pregnant travelers.
 Children under 3 years of age experience
more episodes of TD. See “Traveller's
Diarrhea in Children” fact sheet.
 People who routinely get diarrhea when
they travel.
Where does traveler’s diarrhea occur?
 High risk destinations include most of
Central and South America, Mexico,
Africa, the Middle East and Asia.
 Intermediate risk destinations include
Eastern Europe, South Africa and some of
the Caribbean islands.
How do I become ill with diarrhea?
 TD is usually caused by food
contaminated with bacteria or water
contaminated with microorganisms.
 Bacteria and viruses have an incubation
period of 6 – 48 hours.
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Food may be contaminated through:
- unhygienic food handling practices
- inadequate storage and
transportation of food
- the practice of fertilizing of crops with
human/animal feces
- flies in contact with food
- unreliable refrigeration
- lack of pasteurization
“Food poisoning” involves the ingestion of
preformed toxins in foods and symptoms
usually resolve within 12 hours.
Not all diarrhea is caused by an infection.
Too much sun, alcohol, fruit, spices or greasy
food can also cause diarrhea.
What are the symptoms and signs of TD?
 Sudden onset of loose bowel movements, ≥ 3
per day
 Stomach cramps, bloating, and gas (50-73%)
 Nausea (46-50%), vomiting (15%)
 Fever (37%)
 Weakness/malaise (50-58%)
 Bloody stools (2-10%)
 Dehydration
 Headache
How can I prevent getting TD?
 Wash your hands frequently using soap and
clean water. Use hand sanitizers (60% alcohol
content).
 “Boil it, cook it, peel it, or forget it”. Know
which food and beverages are safer. Refer
to the “Food and Water Safety” fact sheet.
 Dukoral® vaccine provides some protection
against cholera and TD caused by the ETEC
bacteria. It is available through pharmacies.
How can I treat TD?
 Mild – loose stools and minimal symptoms – just
go to the bathroom more frequently, no
treatment required.
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Moderate – loose stools and symptoms
such as nausea, cramps and gas – use
Pepto Bismol if no contraindication,
consider Immodium and if over 10 years
of age, drink up to 2 liters a day of safe
water.
Severe – frequent watery stools with
intense cramps, vomiting, fever, chills, or
bloody stools – use Immodium to prevent
water loss, start oral rehydration, and
antibiotics.
Travelers should feel better within 6 – 24
hours with antibiotic treatment.
How can I prevent dehydration?
 Prevent dehydration by replacing fluids
and electrolytes. This is especially
important for children and the elderly. Buy
a commercial product (e.g. Gastrolyte)
or make your own rehydration solution:
1 litre purified water
8 teaspoons sugar
1 teaspoon salt
Consume oral rehydration solutions within
12 hours, if at room temperature, or within
24 hours if refrigerated.
 Sports drinks (e.g. Gatorade) are not
appropriate for fluid replacement.
 Drink plenty of clear fluids, enough to
produce pale colored urine.
 Avoid milk products, prune juice, orange
juice and apple juice – which may
aggravate diarrhea.
 Drink clear broth or eat salted crackers to
compensate for loss of salt.
 Avoid caffeinated beverages, alcohol
and spicy or greasy foods which tend to
be irritating.
Medications:
 Bring high quality drugs from a reliable
supplier in your own country. 20 – 50% of
the drugs on shelves may be counterfeit.
 For prevention, consider Pepto Bismol
(bismuth subsalicylate) 2 tabs (or 30 ml
liquid) 4 times daily with meals. This can
decrease the incidence of TD by 60%.
Side effects include temporary black
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tongue or stools, nausea, constipation. Do
not use for more than 3 weeks or if you are
allergic to aspirin, have kidney disease, a
bleeding disorder, gout, or take
anticoagulants, probenecid or methotrexate.
Pepto Bismol can interfere with absorption
of doxycycline. It is not approved for
children < 3 years old. For children > 3 years
old, consult a physician or pharmacist.
For treatment, Pepto Bismol 30 ml of liquid or
2 tablets every 30 minutes, for a total of 8
doses, can lessen/shorten diarrhea.
Imodium (loperamide): use for moderate to
severe TD or when bathroom usage is not
convenient, such as a travel day. It is not safe
for children under 2 years of age. Use only on
the advice of a physician for children under
12 years of age and pregnant women. Do
not use Imodium for more than 48 hours if
diarrhea persists.
Antibiotics: Travelers may want to take an
antibiotic for self-treatment. The usual
antibiotics are ciprofloxacin 500 mg twice
daily or norfloxacin 400 mg twice daily, for 1 –
3 days. An alternative antibiotic is
azithromycin 500 mg twice daily for 1-3 days.
Any of these antibiotics may be stopped
after 1 day if symptoms resolve.
Azithromycin is the antibiotic of choice in
Thailand, India and Haiti.
Long-term travellers to Nepal may wish to
consider TMP-SMX for treatment of
Cyclosporiasis.
Please refer to the “TD in Children” and
“Pregnancy and Travel” fact sheets for the
appropriate antibiotics in these groups.
When should I see a doctor?
 Tell your doctor you have been traveling.
 If you have a fever, especially if you've visited
a malarious area.
 If severe diarrhea is not getting better, after
3-4 days, despite treatment.
 If you have any severe medical conditions, a
suppressed immune system, or blood in your
bowel movements.
 If diarrhea lasts more than 2 weeks, stool
specimens are recommended.
For more information, call the International Travel Centre at (306) 655-4780
www.saskatoonhealthregion.ca/internationaltravel
DC-90 (buff)
05-12
© 2007, Saskatoon Health Region