Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Traveler’s Diarrhea

(Montezuma’s Revenge; Turista)
Pronounced: Traveler’s die-ah-ree-ah
by Shara Aaron, MS, RD
Definition

In people traveling to international destinations, particularly in less developed countries, watery, loose stools ( diarrhea ) are most often caused by bacterial or viral infection. Most cases of traveler’s diarrhea resolve within 1-2 days without treatment and 90% resolve within one week.

Causes

The primary cause of traveler’s diarrhea is ingestion of fecally-contaminated food or water. The offending substance carries a bacteria or virus that causes the diarrhea. The common pathogens include:

  • Bacteria
    • Campylobacter jejuni
    • Escherichia coli
    • Salmonella
    • Shigella
    • Yersinia
  • Viruses
    • Enterovirus
    • Norwalk virus
    • Rotavirus

Risk Factors

The most important risk factor for contracting traveler’s diarrhea is destination. Underdeveloped countries with contaminated water supplies pose the highest risk. The following factors increase your chance of developing traveler’s diarrhea. If you have any of these risk factors and plan to travel internationally, tell your doctor:

  • People with diabetes or inflammatory bowel disease
  • Children under two years old
  • People who take acid blockers or antacids
  • People with weak immune systems

Symptoms

If you experience any of these symptoms do not assume it is due to traveler’s diarrhea. These symptoms may be caused by other health conditions:

  • Abdominal cramping
  • Bloating
  • Fever
  • Frequent loose stools (4-5 watery bowel movements a day)
  • Increased frequency and volume of stool
  • Nausea
  • Vomiting
Diagnosis

Your doctor will ask about your symptoms and medical history, and do a physical exam. A stool sample will be taken. This will allow your doctor to identify the pathogen.

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include the following:

Antimotility Agents

Examples of these medicines include:

  • Bismuth subsalicylate (Pepto-Bismol)—This is an over-the-counter medicine that decreases the frequency of stools.
    • Note: This medicine should not be used by:
      • People who have allergies to aspirin or salicylates
      • Children or pregnant women
      • People who take aspirin or similar type drugs (salicylates)
  • Loperamide (Imodium), diphenoxylate and atropine (Lomotil), and opiates—These medicines reduce muscle spasms in the gastrointestinal tract, which slows transit time and increases absorption. Infants and people with bloody diarrhea should avoid these medicines.
Antibiotics

The most common antibiotics for treating traveler's diarrhea include:

  • Ciprofloxacin
  • Doxycycline
  • Norfloxacin
  • Ofloxacin
  • Trimethoprim-sulfamethoxazole

These antibiotics are only effective for treating a bacterial infection.

If you are diagnosed with traveler's diarrhea, follow your doctor's instructions .

Prevention

To help reduce your chance of getting traveler’s diarrhea, take the following steps:

  • Avoid eating foods from street vendors or unhygienic eating establishments.
  • Avoid raw or undercooked meat or seafood.
  • Avoid salads or unpeeled fruits. Have only fruits and vegetables that you peel yourself, such as bananas or oranges.
  • Do not drink tap water or add ice cubes. Drink only bottled water or, if necessary, local water that you have boiled for 10 minutes or treated with iodine or chlorine. Bottled carbonated beverages, steaming hot tea or coffee, wine, and beer are all okay to drink.
  • Eat foods that are fully cooked and served hot.

Last reviewed: December 2010 by David L. Horn, MD, FACP.

RESOURCES:
CANADIAN RESOURCES:
References:
  • Guerrant RL. Practice guidelines for the management of infectious diarrhea. Clinical Infectious Diseases . 2001:32:331-350.
  • Juckett G. Prevention and treatment of traveler’s diarrhea. Am Fam Physician . 1999;60:119-136.
  • Yates J. Traveler’s diarrhea. Am Fam Physician . 2005;71:2095-2100,2107-2108.