Traveler's diarrhea (patient information)
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Overview
- Travelers’ diarrhea is the most common travel-related illness.
- Attack rates range from 30% to 70% of travelers, depending on the destination and season of travel.
What are the symptoms of Traveler's diarrhea?
- Bacterial and viral TD presents with the sudden onset of bothersome symptoms that can range from mild cramps and urgent loose stools to severe abdominal pain, fever, vomiting, and bloody diarrhea, although with norovirus vomiting may be more prominent.
- Untreated bacterial diarrhea lasts 3–7 days. Viral diarrhea generally lasts 2–3 days. Protozoal diarrhea can persist for weeks to months without treatment.
What causes Traveler's diarrhea?
- Traveler's diarrhea may be caused by an infection with either bacteria, virus, or parasite.
- E. coli (bacterium) is the most common cause of traveler's diarrhea. It is responsible for approximately 70% to 80% of all cases of traveler's diarrhea.
Who is at highest risk?
The most important determinant of risk is travel destination, and there are regional differences in both the risk for and etiology of diarrhea. The world is generally divided into 3 grades of risk: low, intermediate, and high.
- Low-risk countries include the United States, Canada, Australia, New Zealand, Japan, and countries in Northern and Western Europe.
- Intermediate-risk countries include those in Eastern Europe, South Africa, and some of the Caribbean islands.
- High-risk areas include most of Asia, the Middle East, Africa, Mexico, and Central and South America.
Diagnosis
- Traveler's diarrhea is diagnosed when the following criteria are met: passage of ≥3 unformed stools per day plus ≥1 associated enteric symptoms, such as abdominal pain or cramps, occurring in a traveler after arrival, usually in a resource-limited destination.
- In acute cases of traveler's diarrhea that are not complicated by other diseases, traveler's diarrhea does not require additional laboratory testing and may be diagnosed only by the clinical features.
- Additional testing may be required for patients with long-term diarrhea that is not resolving by antibiotics and for patients who show signs or symptoms other than those that are related to traveler's diarrhea, which may suggest development of complications.
Treatment options
Fluid Replacement
Fluid Replacement
- People with diarrhea should drink lots of fluids to stay hydrated. This is especially important for young children or adults with chronic illnesses.
- In serious cases of travelers’ diarrhea, oral rehydration solution—available online or in pharmacies in developing countries—can be used for fluid replacement.
Antibiotics
- Many travelers carry antibiotics with them so they can treat diarrhea early if they start to get sick.
- The choice of antibiotics varies depending on the destination. Ask your doctor if you should take an antibiotic on your trip.
Over-the-Counter Drugs
- Several drugs, called antimotility drugs, can be bought over-the-counter to treat the symptoms of diarrhea.
- These drugs decrease the frequency and urgency of needing to use the bathroom, and they may make it easier for a person with diarrhea to ride on a bus or airplane while waiting for an antibiotic to take effect.
What to expect (Outlook/Prognosis)?
- Most cases of traveler's diarrhea are self-limited with an excellent outlook/prognosis.
- In some patients, especially those with concomitant diseases that cause suppression of immunity (e.g. transplant patients or HIV-positive patients), the prognosis may be poorer, and prompt diagnosis and treatment are required to improve the outcomes of the disease.
Prevention
- In otherwise healthy adults, diarrhea is rarely serious or life-threatening, but it can certainly make for an unpleasant trip.
- For travelers to high-risk areas, several approaches may be recommended that can reduce, but never completely eliminate, the risk for traveler's diarrhea.
- Take steps to avoid diarrhea when you travel:
Eat & Drink Safely
Choose foods and beverages carefully to lower your risk of diarrhea (see Food & Water Safety). Eat only food that is cooked and served hot. (Avoid, for example, food that has been sitting on a buffet.) Eat raw fruits and vegetables only if you have washed them in clean water or peeled them. Drink only beverages from factory-sealed containers, and avoid ice (because it may have been made from unclean water).
Keep Your Hands Clean
Wash your hands often with soap and water, especially after using the bathroom and before eating. If soap and water aren’t available, use an alcohol-based hand sanitizer. In general, it’s a good idea to keep your hands away from your mouth.
Prophylactic Antibiotics
- At this time, prophylactic antibiotics (i.e. antibiotics given before having the disease to prevent the disease from occurring) should not be recommended for most travelers.
- Prophylactic antibiotics afford no protection against nonbacterial pathogens and can remove normally protective microflora from the bowel, which could make a traveler more susceptible to infection with resistant bacterial pathogens.
- A traveler relying on prophylactic antibiotics will need to carry an alternative antibiotic to use in case diarrhea develops despite prophylaxis.
- Additionally, the use of antibiotics may be associated with allergic or adverse reactions in a certain percentage of travelers and may potentially contribute to drug resistance.
- Nonetheless, prophylactic antibiotics are effective in the prevention of some cases of traveler's diarrhea.
- The use of prophylactic antibiotics should be weighed against the result of using prompt, early self-treatment with antibiotics when traveler's diarrhea occurs, which can limit the duration of illness to 6–24 hours in most cases.
- Prophylactic antibiotics may be considered for short-term travelers who are high-risk hosts (such as those who are immunosuppressed) or who are taking critical trips (such as engaging in a sporting event) during which even a short bout of diarrhea could affect the trip.