Travelers' Diarrhea: What You Need to Know
An Interview with CDC Travel Health Expert Phyllis Kozarsky
Is it okay to take Lomotil, Lonox, or Imodium to relieve travelers' diarrhea?
When we look at anti-diarrheal agents, the most important are those that stop symptoms immediately, such as Imodium and Lomotil. We prefer Imodium, because it does not make you feel drugged and sleepy, but does stop your symptoms. [Note: Imodium is one of several brand names for loperamide. Lomotil and Lonox are brand names for diphenoxylate combined with atropine].
Remember that these agents do not cure the illness. They just stop you up and thus stop the cramping. These drugs are fine to take immediately, right after you feel that urge and pass that first loose stool. It will make you feel better faster.
Some people think that it is not a good idea to take agents such as these with diarrhea because it's better to purge all the "bad stuff" that's in you. But a number of studies show taking something like Imodium does not prolong illness. Now people with high fever or bloody stools or terrible abdominal symptoms should NOT take these drugs. They should seek medical attention.
For people with mild to moderate travelers' diarrhea, there is nothing wrong with taking Imodium and a dose of antibiotic at the same time. For mild diarrhea, if you do not have an antibiotic or are just looking for temporary relief, it is fine to take these drugs without an antibiotic. But if you're looking for a cure and want and need to move on with your travels, in general, it is good to take an antibiotic as well. One to three days of antibiotics will cure most cases of travelers' diarrhea.
What antibiotic should I take for travelers' diarrhea?
It depends. For adults, ciprofloxacin is used most commonly. Sometimes, for those traveling to certain places in Southeast Asia, where bacterial pathogens have increased resistance, some doctors like to prescribe azithromycin. In some cases where you feel that the traveler may likely be exposed to just the coliform pathogens such as E. coli, some prescribe rifaximin.
Of course, antibiotics work only for bacterial causes of travelers' diarrhea. Know that even bacterial travelers' diarrhea usually gets better without antibiotic treatment, although rehydration is always advised and symptoms may take 3 to 5 days or more to subside without treatment.
For those with diarrhea due to parasitic infections, there are agents that are specific for each type of infection. However, for Giardia infections, tinidazole [Tindamax] is often prescribed and is very effective.
Should I see a doctor before starting antibiotics for travelers' diarrhea?
Actually, for self-treatment in the field, we don't really encourage travelers to touch base with a provider before starting treatment. Many travelers will be in areas where providers may not be up to the standard of care that travelers are used to, or may be in places where the medications they can obtain are not safe -- there is a big market in counterfeit medications in some developing nations.
So we urge people to get the medications they may need -- and some education on when and how to use them -- from their provider before traveling. Then they can self-treat as long as they have only a mild to moderate case of travelers' diarrhea.