Travelers' Diarrhea

The most common illness that travelers will be exposed to abroad is travelers' diarrhea. It is a syndrome characterized by the passage of 3 or more unformed stools in a twenty-four hour period. Although it is a self-limited disease, travelers' diarrhea can last 3-4 days. Ten percent of cases last longer than 1 week, and approximately 2% last a month or more. Travelers can also experience more than one episode.

Causes: Travelers' diarrhea is caused by bacteria, protozoa or viruses that are ingested by eating contaminated food or beverages. For short-term travelers in most areas, bacteria are the cause of the majority of diarrhea episodes.

Prevention: The best prevention strategy is to "boil it, cook it, peel it, or forget it" when it comes to food and beverages eaten abroad. But even with the best prevention strategies, travelers' diarrhea still occurs because it is difficult to observe the requisite dietary restrictions 100% of the time. For those traveling abroad to countries at high risk of travelers' diarrhea for less than three weeks, the CDC advises that bismuth subsalicylate (the active ingredient in Pepto Bismol) taken 2 ounces four times a day, or two tablets four times a day, can decrease the incidence of diarrhea by 60%. Side effects include blackening of the tongue and stools, occasional nausea and constipation, and rarely, tinnitus. Bismuth subsalicylate should be avoided by travelers with aspirin allergy, renal insufficiency and gout, and by those who are taking anticoagulants, probenecid, or methotrexate.

for a printable handout on Travelers' Diarrhea.