Traveler's diarrhea is loose, watery, and frequent stools that occur after visiting areas with contaminated water supplies, poor sewage systems, or improper food handling. High-risk destinations include third world or developing countries, including Latin America, Africa, the Middle East, and Asia.

This article discusses the appropriate foods and fluids to consume if you develop traveler's diarrhea.

See also: Diarrhea

Bacteria and their toxins in the water and food supply cause traveler's diarrhea. (People living in these areas often don't get sick because their bodies have developed some degree of immunity.)

You can decrease your risk of developing traveler's diarrhea by avoiding water, ice, and food that may be contaminated. The goal of the traveler's diarrhea diet is to reduce the impact of this illness and avoid severe dehydration.

Traveler's diarrhea is rarely life-threatening for adults. It is more serious in children as it can frequently lead to dehydration.

Prevention of traveler's diarrhea:

• Water:
  • Do not use tap water for drinking or brushing teeth.
  • Do not use ice made from tap water.
  • Use only boiled water (at least 5 minutes) for mixing baby formula.
  • For infants, breast-feeding is the best and safest food source. However, the stress of traveling may decrease milk production.
• Other beverages:
  • Drink only pasteurized milk.
  • Drink bottled drinks if the seal on the bottle hasn't been broken.
  • Carbonated drinks are generally safe.
  • Hot drinks are generally safe.
• Food:
  • Do not eat raw fruits and vegetables unless you peel them.
  • Do not eat raw leafy vegetables (e.g. lettuce, spinach, cabbage); they are hard to clean.
  • Do not eat raw or rare meats.
  • Avoid shellfish.
  • Do not buy food from street vendors.
  • Eat hot, well-cooked foods. Heat kills the bacteria. Hot foods left to sit may become recontaminated.
• Sanitation:
  • Wash hands often.
  • Watch children carefully. They put lots of things in their mouths or touch contaminated items and then put their hands in their mouths.
  • If possible, keep infants from crawling on dirty floors.
  • Check to see that utensils and dishes are clean.

Treatment:

If you or your child get diarrhea, continue eating and drinking. For adults and young children, continue to drink fluids such as fruit juices and soft drinks (noncaffeinated). Salted crackers, soups, and porridges are also recommended.

Dehydration presents the most critical problem, especially for children. Signs of severe dehydration include:

• Decreased urine (fewer wet diapers in infants)
• Dry mouth
• Sunken eyes
• Few tears when crying

Oral rehydration fluids are advised for children with traveler's diarrhea to prevent severe dehydration. These fluids contain salts (mainly sodium, potassium, and chloride) with small amounts of glucose (a form of sugar). They replace lost fluids and minerals. Most stores in the United States sell rehydration fluids in the infant section. In third world countries, many health agencies stock packets of salts to mix with water.

If rehydration fluids are not available, you can make an emergency solution as follows:

• 1/2 teaspoon of salt
• 2 tablespoons sugar or rice powder
• 1/4 teaspoon potassium chloride (salt substitute)
• 1/2 teaspoon trisodium citrate (can be replaced by baking soda)
• 1 liter of clean water

Give the child small amounts to drink often. Small amounts decrease the likelihood of vomiting. One guideline is to give one cup of fluid for every loose stool passed.

If you or your child have signs of severe dehydration, or if fever or bloody stools develop, seek immediate medical attention.

There is no vaccine against traveler's diarrhea. However, your doctor may recommend medicines to help reduce your chances of getting sick. For example, taking two tablets of Pepto-Bismol four times a day before and during international travel can help prevent many cases of diarrhea. Pepto-Bismol should not be taken for more than 3 weeks.

Prophylactic antibiotics are those used to prevent diarrhea while traveling. At this time, prophylactic antibiotics are not generally recommended unless the person is at increased risk for complications of traveler's diarrhea. People at such risk include those with chronic bowel diseases, kidney disease, diabetes, or HIV.

Arguin P. Approach to the patient before and after travel. In: Goldman L, Ausiello D, eds. Cecil Textbook of Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 308.

Hill DR, Ericsson CD, Pearson RD, et al. The practice of travel medicine: guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006;43:1499-1539.