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Travelers' Diarrhea: What You Need to Know

An Interview with CDC Travel Health Expert Phyllis Kozarsky
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WebMD Feature

What do we all need to know about travelers' diarrhea? WebMD asked Emory University professor Phyllis Kozarsky, MD, the CDC's expert travel health consultant.

What is travelers' diarrhea?

Travelers’ diarrhea is often used as a generic term  for any illnesses ranging from an upset tummy to  loose stools during or after travel. It could mean just excess gas, or a variety of symptoms that can occur from a change in the types of food or beverages we are used to – or, most commonly, to contamination of food or beverages. And it's not just food and beverages. Touching your mouth or nose with contaminated hands may be all it takes.

How can I prevent travelers' diarrhea?

People often discuss the importance of care in selecting "safe" foods and beverages for consumption. We recommend that foods be freshly cooked and be piping hot; such foods are safer than those on a buffet that have been sitting out for hours. Water should be bottled and sealed, or boiled. Alcohol is OK, but ice cubes are not. 

But sometimes people do everything they are supposed to do regarding the selection of food and beverages and still get sick. Often, it's really the lack of sanitation within the food industry -- contamination may occur anywhere from when the food comes out of the ground to the preparer or the server. Food can be tainted at any point along that route. So restaurant hygiene and food service worker hygiene may be out of the traveler's control, but both play a role in whether disease is transmitted.

And sometimes it’s the travelers who contaminate themselves. Remember: Try to clean your hands before eating, whether with soap and water or a hand sanitizer. And travelers should avoid touching their face, mouth, or mucous membranes with their hands.

Can medications prevent travelers' diarrhea?

Yes. Pepto-Bismol has been used for a number of years to prevent travelers' diarrhea. Studies show that if adults take the equivalent of two tabs four times a day, it can decrease the incidence of travelers’ diarrhea up to 60%.

Now, many people who take that amount of Pepto-Bismol end up with severe constipation. I take two tabs twice a day when I go into a risky situation. I do believe that it is very helpful, but most recommend if you’re going to do this, that it should just be for short-term -- up to three weeks.

While this helps many people, those allergic to aspirin cannot take it. And if you're taking prescription medications, you should check with your doctor to see if you can take this.

Some swear by probiotics like lactobacillus for preventing travelers' diarrhea. But studies of this strategy in limited numbers of subjects are inconclusive.

And some people are given prophylactic antibiotics, which are very effective in preventing travelers' diarrhea, but the problem there is we don't feel very good about prescribing antibiotics for a number of reasons for someone if they don’t need them. There are issues such as side effects, or of diarrhea caused by the antibiotics themselves, and increased antibiotic resistance in the normal organisms we harbor in our bodies. Rarely, if it is just for a very important weekend, or occasionally for government officials or someone in an athletic competition, we may prescribe preventive antibiotics.

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