Causes | Prevention | Treatment | Infant Diarrhea

Travelers' diarrhea (TD) is the most common cause of illness in travelers. Common symptoms, related to the diarrhea, include abdominal cramps, nausea, bloating, urgency, fever and malaise.

The CausesTop

TD is acquired through ingestion of fecally contaminated food and water. Risky foods and drinks are those discussed previously, and are considered risky because they may carry the infectious agents capable of causing TD. Travelers who go from industrialized to developing nations frequently develop a rapid change in the type of organisms in their gastrointestinal tract. Some of these new organisms are potential TD-causing organisms, and those travelers who develop TD have ingested enough of them to overcome those residing normally in their gut.

PreventionTop

Always wash your hands with soap and water before eating. This prevents transferring diarrhea-causing bacteria or parasites to your food or mouth. For the same reasons, you should always wash your hands after changing a child's diaper.

Follow the rules of diet. Be Waterwise and Be Foodwise.

Prophylactic antibiotics are not recommended for travelers. Sensible dietary practices are the best prophylactic measure, and are justified by the excellent results of early treatment of TD.

You might consider prophylaxis with Pepto-Bismol® (2 tablets 4 times a day) if you will be traveling short term (less than 2 weeks) and cannot afford to have your trip interrupted or travel plans altered because of illness.

TreatmentTop

Simplify your illness; don't share it with family or friends. If you have diarrhea, be sure to wash your hands after using the toilet. You can easily spread diarrheal diseases to others through person-to-person contact, or through food that you have touched during preparation.

Call a Physician?

If diarrhea is severe or does not resolve within several days; if there is blood in the stool; if fever occurs with shaking chills; or if there is persistent voluminous diarrhea, which could induce dehydration, you should consult a physician rather than attempt self-medication.

Treatment Agents

Individuals with TD have two major complaints for which they desire relief­abdominal cramps and/or diarrhea. The following agents, taken as directed, will offer some relief:

Nonspecific: Kaolin and pectin (Kaopectate®) have been widely used for diarrhea, but have not proven to be very effective.

Bismuth subsalicylate preparation, Pepto-Bismol®, taken as 1 oz of liquid or two 26.5 mg tablets every

30 minutes for 8 doses. NOTE: There is concern about taking large amounts of bismuth and salicylate, especially for those individuals who may be unable to take salicylates, who have kidney disease, or who take salicylates for other reasons. In addition, people suffering from typhoid fever can be hypersensitive to the fever-lowering effect of salicylates. Use caution. Consult a physician if there are any concerns.

Antimotility Agents: Loperamide (Imodium®), sold over the counter, comes in a convenient dosage form and provides prompt symptomatic but temporary relief of uncomplicated TD. However, it should not be used in patients with high fever or with blood in their stool. This drug should be discontinued if symptoms persist beyond 48 hours. Loperamide should not be used in children under the age of 2. The older drug, Lomotil®, available only by prescription, contains an active ingredient believed not to be as effective as loperamide, plus another one not as helpful, atropine. It is no longer as highly recommended.

Antimicrobial Treatment: Travelers who develop diarrhea with three or more loose stools in an 8-hour period, especially if associated with nausea, vomiting, abdominal cramps, fever, or blood in the stools, may benefit from antimicrobial treatment. See a physician. A typical 3-day illness can often be shortened by an antibiotic regimen such as Bactrim® DS or Septra® DS taken twice daily. One day, up to a maximum of three days of treatment, is usually recommended. Ciprofloxacin 500 mg, often as a single dose, may shorten the course, but 1 pill, twice a day, for a maximum of three days, may be required for more severe illness.

Food and Water: Your intestine continues to absorb water and nutrients despite diarrhea. Remember that food, especially easy-to-digest starches, reduces the volume of diarrhea. Food enhances water absorption and is a source of sodium and energy providing calories. Soup or broth, plus toast or salted crackers, is an excellent starting diet. (The best soups are lightly salted rice and noodle soups.) The BRAT diet (bananas, rice, applesauce, toast) is easily remembered and well tolerated.

Oral Fluids: Most cases of diarrhea are self-limited and require only simple replacement of fluids and salts. In children rehydration is of paramount importance since their small bodies become dehydrated so much more easily. This is best achieved by use of an oral rehydration solution such as World Health Organization (WHO) Oral Rehydration Salts (ORS) Solution. This solution is appropriate for treating as well as preventing dehydration. ORS packets are available at stores or pharmacies in almost all developing countries. It is prepared by adding one packet of ORS to boiled or treated water. The proper concentration of the solution is important; therefore, packet instructions should be followed carefully to ensure that the salts are added to the correct volume of water.

Top
Oral Rehydration Fluids (ORS)-Recipes:

1) Quick ORS­One teaspoon of salt and 2 to 3 tablespoons of sugar or honey to 1 liter of water.

2) Quick ORS­Mix one 8-oz cup of orange juice (or other fruit juice) with 3 cups of water and add 1 teaspoon of salt.

3) Homemade ORS­1 liter clean water, 1/2 tsp. table salt, 1/4 tsp. salt substitute (KCl), 1/2 tsp. baking soda, 2 to 3 tbs. sugar, or 2 tbs. honey or Karo syrup.

Infants with DiarrheaTop

Children aged 0 to 2 years are at high risk of acquiring travelers' diarrhea and at great risk of dehydration. Dehydration is best prevented by use of WHO ORS solution in addition to the infant's usual diet. The infant who vomits the ORS will usually keep it down if the ORS is offered in frequent small sips by spoon. Breast-fed infants should continue nursing on demand. For bottle-fed infants, full-strength lactose-free, or lactose-reduced formulas should be administered. Older children receiving semisolid or solid foods should continue to receive their usual diet during diarrhea. Recommended foods include starches, cereals, yogurt, fruits and vegetables, or the BRAT diet discussed earlier.

Watch It, All Liquids Are Not Equal

The high sugar content of many drinks will draw water out of the intestine, increase diarrhea, worsen dehydration, and possibly lead to a condition called hypernatremia. Do not give apple juice, grape juice, cola, 7-Up®, Jell-O®, Gatorade®, orange juice or ginger ale, unless heavily diluted. Refer to the section describing Oral Rehydration Solution (ORS).