Travelers to less developed parts of the world often developed gastrointestinal complaints that mar their vacations or business trips. Diarrhea is by far the most common health problem of travelers to developing countries. Of the more than 40 million travelers annually from industrialized to developing countries. Approximately one third suffer from this complaint.

What Causes Traveler's Diarrhea?
Virtually all cases of traveler's diarrhea are caused by infectious agents through ingestion of contaminated food or water. Especially risky foods include raw vegetables, raw meats and raw seafood. Foods sold by street vendors are a common source of enteropathogens. Overall, the most common infectious organisms are enterotoxigenic E. coli bacteria, which are responsible for 50 to 75 percent of illnesses. Less common causes include other bacteria (such as shigella, salmonella, campylobacter and virbrio parahemolyticus), viruses (such as rotavirus) and parasites (such as amoeba and giardia).

Treatment
Although fluid loss may not be excessive, it is advisable to drink plenty of fluids. Bismuth subsalicyclate, taken as Pepto-Bismol liquid 60 mls four times a day, can decrease symptoms. However, this medication should be avoided for those individuals who do not tolerate salicyclates, are allergic to aspirin, have kidney problems or are taking anti-coagulants, probenecid or methotrexate. Side effects include blackening of the tongue and stool and occasionally nausea, constipation and ringing of the ears.

Diphenoxylate (Lomotil) and loperamide (Imodium) provide symptomatic relief of simple diarrhea. However, antibiotics may be required if symptoms persist longer than 48 hours or are accompanied by high fever or blood in stool. A single dose of cipfloxacin, levofloxacin or ofloxacin usually relieves the symptoms in less than 24 hours, but longer courses are sometimes necessary. Trimethoprim-sulfamethoxazole (Bactrim, Septra, Septrin) can be used for children, but resistance to these antibiotics have become common. Some antibiotics, such as ciprofloxain, ofloxacin and norfloxacin, taken on a daily basis have been shown to reduce the incidence of traveler's diarrhea. However, because of the calculable risk of adverse reactions and the generally self-limiting course of traveler's diarrhea, prophylactic antibiotics are not routinely recommended.

Prevention Recommendations

- Avoid eating fruit that you cannot peel.
- Avoid eating raw seafood or vegetables.
- Avoid eating food that is not adequately cooked and served piping hot.
- Avoid drinking beverages that are not boiled, packaged or bottled. Also avoid putting ice in beverages. Freezing does not kill many virus or bacteria.
- Ice cream and milk products from unreliable sources are a frequent source of intestinal infections. Do not drink milk unless it has been pasteurized or boiled.

This information is meant as a general guideline. It is best to consult your doctor if symptoms are severe or persist more than a few days.