Straight, No Chaser: Travelers’ Diarrhea


This is the time of year in the U.S. when you wished you were somewhere else. (Hawaii, Africa, Australia or Mexico for a Valentine’s Day cruise, anyone?) Unfortunately, sometimes when you travel, you get more than you hoped.
“Montezuma’s Revenge” is often the punchline of a joke in the U.S., but travelers’ diarrhea (TD) is a serious concern. It is the most common illness contracted by travelers, affecting approximately 10 million people per year. Individuals visiting the U.S. can suffer from it as well. That’s a clue as to what’s actually occurring with TD.
TD is typically a response to an infection by a strain of bacteria known as E. coli, specifically, a strain that produces a toxin that affects the intestines. This is the case approximately 80% of the time. Parasites sometimes figure prominently in the illness. The risk and primary source of this infection is food or water that is contaminated with feces. Note that most any disturbance in the bacterial balance of the intestines can cause disruptions in the digestive system, leading to diarrhea.


Although anyone can contract TD, destinations and personal characteristics can markedly increase that risk.

  • Higher risk destinations include developing countries in Africa, Asia, Latin America and the Middle East.
  • Those individuals at higher risk include the immunocompromised, diabetics, young adults, those with inflammatory bowel disease and those taking antacids or medicines known as H-2 blockers.

TD is straightforward. Symptoms include watery diarrhea and cramps. A mild fever may or may not be present.
So, what are you supposed to do to prevent TD? This stuff is miserable! Here are a few tips and pointers for you:

  • Avoid street vendors.
  • Avoid raw or undercooked foods (especially meats and seafood).
  • Avoid raw fruits and vegetables (unless you peel them).
  • Wash your hands!
  • Taking antibiotics in advance (prophylactically) is not recommended, because they can increase your susceptibility to resistant organisms and side effects.
  • Bismuth subsalicylate (two ounces or two tablespoons four times daily) reduces the incidence of TD. Speak to your physician or SMA expert consultant about the risks and indication of taking bismuth subsalicylate. By the way, you know bismuth subsalicylate as pepto-bismol or kaopectate.

And now, a few words about treatment. Here are a few considerations about which you should be aware.

  • TD is usually mild and will run its course without medication. In other words, you’re likely to be just fine.
  • The most important consideration is to ensure adequate hydration. Clear fluids are key.
  • You may need antibiotics if symptoms progress to include fever, bloody stools, nausea, vomiting and severe cramps. Drugs typically include ciprofloxacin and norfloxacin. Previously used drugs such as trimethoprim-sulfamethoxazole and doxycycline aren’t recommended anymore because of the high resistance rate.
  • Bismuth subsalicylate may also be used as treatment (in addition to its role in prevention).
  • A  special word about anti-motility (anti-diarrhea) medications: There are some benefits to using these agents, but there are also significant risks. You should not take these medications without understanding the risks and how they may affect you based on your existing health profile. This topic is discussed in greater detail at, and you certainly can discuss this further with your SMA personal healthcare consultant.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

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