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Immunizations and Antibiotics for Oversea Travel (cont.)

Traveler's Diarrhea Prevention and Treatment

  • Local water and food that is undercooked are often the cause of traveler's diarrhea (TD).
  • In general, drink and eat only packaged liquids, food that is steaming hot, or fruit that you have peeled yourself. Do not use ice in areas where water can be contaminated, and avoid salads and other fresh foods. Do not eat foods from roadside vendors or brush your teeth using tap water. Despite precautions, illness rates can be up to 50%.
  • Although not without controversy, a number of experts recommend using probiotics, such as Lactobacillus GG and Saccharomyces boulardii, to help prevent traveler's diarrhea.
  • Two Pepto-Bismol tablets taken four times per day can decrease the incidence of traveler's diarrhea by about 60%. Pepto-Bismol turns a person's tongue or stools black. People who are sensitive to aspirin, people taking certain drugs (for example, blood thinners, methotrexate, probenecid), and those with kidney problems should avoid Pepto-Bismol. It should not be given to children younger than 12 years of age.
  • One or two Imodium tablets every four hours as needed can reduce the frequency of stools, but people with fever or bloody stools should not use this agent without a doctor's order.
  • Certain antibiotics (such as trimethoprim-sulfamethoxazole or ciprofloxacin) can reduce the duration of symptoms in cases of bacterial infection; however, these agents should not be used to prevent infection. In order to control the resistance of bacteria to currently effective antibiotics used to treat traveler's diarrhea when it does occur, the CDC advises against the use of antibiotics to prevent traveler's diarrhea. However, many clinicians will prescribe ciprofloxacin 500 mg to be taken twice daily for three days if the traveler develops significant diarrhea (more than three stools in eight hours or five stools in 24 hours).
  • Oral rehydration therapy (ORT): The World Health Organization recommends the following salt solution mixture: 3.5 grams of salt (for example, sodium chloride), 1.5 grams of potassium chloride, 20 grams of glucose, and 2.9 grams trisodium citrate (alternatively, 2.5 grams sodium bicarbonate). These ingredients should be mixed in 1 liter of clean water. This will improve rehydration by providing both salts and glucose, which increase transport of both substances across the intestinal wall. Premixed commercial ORT preparations (such as Pedialyte) are available for children.

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