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Traveler's diarrhea

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Diseases & Conditions  

Traveler's diarrhea may be caused by any of several bacteria, viruses, or parasites. However, enterotoxigenic E. coli is the most common cause. E. coli organisms are commonly present in the water supplies of areas that lack adequate water purification.


Don't drink the water
One of the simplest and most effective ways to reduce your risk of traveler's diarrhea is to avoid contaminated water. When visiting high-risk countries, keep the following tips in mind:

  • Never drink unsterilized water — from tap, well or stream. If you need to consume local water, boil it for five to ten minutes.

  • Avoid ice cubes or fruit juices made with tap water.

  • Beware of sliced fruit that may have been washed in contaminated water.

  • Don't swim in water that may be contaminated.

  • Keep your mouth closed in the shower.

  • Feel free to gulp down canned or bottled drinks in their original containers — including water, carbonated beverages, beer or wine — as long as you break the seals on the containers yourself. Wipe off any can or bottle before drinking or pouring.

  • Use bottled water to brush your teeth.

  • Use bottled or boiled water to mix baby formula.

  • Order hot beverages such as coffee or tea, and make sure they're steaming hot.

If it's not possible to buy bottled water or boil your water, bring some means to purify water: Consider a water filter pump with a microstrainer filter that can filter out small microorganisms. Look at camping stores for a filter that is certified by the National Science Foundation (NSF). Or chemically disinfect water with iodine or chlorine. Iodine tends to be more effective, but is best reserved for short trips, as too much iodine can be poisonous to your system. You can purchase iodine tablets or crystals at camping stores and pharmacies. Be sure to carefully follow the directions.

Watch what you eat
The general rule of thumb is this: Boil it, cook it, peel it or forget it. Unfortunately, most travelers don't stick to these guidelines 100 percent of the time. Remember these tips:

  • Don't buy food from street vendors or in other unsanitary places.

  • Avoid unpasteurized milk and dairy products, including ice cream.

  • Avoid raw or undercooked meat, fish and shellfish.

  • Steer clear of moist food at room temperature such as sauces and buffet offerings.

  • Eat foods that are well cooked and served hot.

  • Munch on dry foods — like breads — and high-sugar content foods, such as jellies and syrups.

  • Stick to fruits and vegetables that you can peel yourself, such as bananas, oranges and avocados. Stay away from salads and unpeelable fruits such as grapes and berries.

More traveling tips
Here are other ways to reduce your risk of traveler's diarrhea:

  • Make sure dishes and utensils are clean and dry before using them.

  • Wash your hands often and always before eating.

  • Seek out food items that require little handling in preparation.

  • Keep children from putting things — including their dirty hands — in their mouths. If possible, keep infants from crawling on dirty floors.

  • Tie a colored ribbon around the bathroom faucet to remind you not to drink — or brush your teeth with — tap water.

Public health experts generally don't recommend taking antibiotics to prevent traveler's diarrhea, because doing so can contribute to the development of antibiotic-resistant bacteria. Besides, antibiotics provide no protection against viruses and parasites, but they can give travelers a false sense of security about the risks of consuming local foods and beverages. They can also cause unpleasant side effects, such as skin rashes, skin reactions to the sun, vaginal yeast infections and, rarely, blood disorders.

As a preventive measure, some doctors suggest taking bismuth subsalicylate (Pepto-Bismol), which has been shown to decrease the incidence of diarrhea. However, don't take this medication for longer than three weeks, and don't take it at all if you're allergic to aspirin, pregnant or taking certain medications such as anticoagulants. Common harmless side effects include a black-colored tongue and dark stools. In some cases it can cause constipation, nausea and, rarely, ringing in your ears (tinnitus).

Researchers are working on a vaccine that could prevent most cases of traveler's diarrhea by protecting against the most common infectious causes. But a traveler's diarrhea vaccination is still a long way off.


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