Tip #1: Understand traveller’s diarrhea
What is traveller’s diarrhea?
There are several possible causes of this condition. The effects of stress on your digestive system caused by jet lag or the consumption of unusual foods may suffice to trigger gastric and intestinal discomfort.
However, traveller’s diarrhea is very often caused by exposure to bacteria, parasites or local viruses that a visitor’s immune system is unprepared to fight.
This infectious disease is generally transmitted via contaminated water or food, but it can also spread through contact with an infected individual.
What are the symptoms associated with turista?
Symptoms of traveller’s diarrhea depend on the bacteria, the parasite or virus involved. These include:
- Diarrhea (by definition, more than 3 episodes of unformed stool within 24 hours)
- Bloating
- Abdominal cramps
- Nausea
- Vomiting
- Fever (generally lower than 38.5 °C)
As a general rule, traveller’s diarrhea is not a cause for serious concern. Symptoms disappear in a few hours or days, without treatment. It is however advisable, in more worrisome cases, that medicine be taken or a doctor be seen, as explained below.
Which areas pose the greatest risk of contracting traveller’s diarrhea?
Travellers are prone to experiencing gastrointestinal symptoms no matter their destination, but more so in places where public health and hygiene conditions are inadequate.
High-risk areas for contracting traveller’s diarrhea
- Developing countries in Central and South America
- Mexico
- Africa
- Middle East
- Asia
Moderate-risk areas for contracting traveller’s diarrhea
- Eastern Europe
- South Africa
- Certain parts of the West Indies
Low-risk areas for contracting traveller’s diarrhea
- Northern and Western Europe
- Australia
- New Zealand
- Japan
- United States of America
- Canada
Tip #2: Visit a travel health clinic
Ask for a consultation at a travel health clinic as soon as possible, ideally at least 6 weeks prior to your departure, considering that certain vaccines can require a certain amount of time before reaching their full efficacy.
Travel health clinic: a service provided at your Accès pharma chez Walmart pharmacy
Look no further! To be seen without delay at a traveller’s clinic and avoid waiting at the pharmacy, schedule an appointment online.
Traveller’s diarrhea vaccine?
A turista vaccine does exist, but its efficacy is relatively limited, as it only prevents the illness in a little more than one in five people. This vaccine is administered orally in two doses taken one week apart.
Immunization against traveller’s diarrhea may be appropriate in certain situations and for certain people who present a high risk of complications. To find out if the traveller’s diarrhea vaccine is a good option for you, ask your pharmacist affiliated with Accès pharma.
What treatments are prescribed in cases of traveller’s diarrhea?
Preventively, your pharmacist may prescribe and fill your prescription for certain medications and health products to use if need be. They will determine the best options and will explain the protocol to be followed depending on your age and the state of your health.
Treatments recommended for traveller’s diarrhea include:
- Oral rehydration solutions (e.g., Gastrolyte®)
- Bismuth subsalicylate (e.g., Pepto-Bismol®), which acts by reducing the secretion of acid in the stomach
- Loperamide (e.g., Imodium®), with the effect of slowing bowel function
- Antibiotics such as quinolones (most often prescribed), azithromycin, rifaximin, etc., which directly fight pathogenic microorganisms
Further we will cover the basic principles to follow when using these classes of medicines. Do make sure, however, that you follow your pharmacist’s and/or doctor’s recommendations dutifully.
Tip #3: Take all necessary precautions to avoid contracting turista during your trip
By following a few simple principles and abstaining from high-risk drinks and foods, you can avoid traveller’s diarrhea altogether and fully enjoy your trip.
Choose the places where you eat with caution
Meals prepared at home are usually safer, followed by restaurant meals. Buffet fare and street food are considered the riskiest.
Of course, it all depends on sanitary and hygiene practices adopted during food and drink preparation. Use your best judgment! In case of doubt, it is best to abstain.
Wash your hands frequently
When done thoroughly and using soap, washing one’s hands using warm tap water is an efficient way to eliminate germs. Some studies seem to indicate that hand-washing alone can reduce the risk of contracting turista by about 30%.
If you do not have access to running water and soap, use an alcohol-based hand sanitizer. Remember to clean your hands often, particularly prior to meals.
Avoid high-risk drinks and foods
The golden rule: “Boil it, cook it, peel it or forget it!”
To avoid coming into contact with microbes that cause traveller’s diarrhea, you will have to make certain sacrifices and avoid risky drinks and foods entirely:
- Tap water or any untreated water
- Ice cubes, as well as powder-based juices/milks or those made from concentrate, as these may have been prepared using untreated water
- Any bottled water or drink unless it was uncapped before your eyes
- Raw fruits and vegetables rinsed in untreated water, unless they can be peeled
- Fresh food left uncooked, unboiled or unpeeled, particularly: raw meats, shellfish, seafood and fish
- Cold cuts
- Unpasteurized dairy products (milk, cheese, butter)
- Raw eggs or raw-egg-based products such as mayonnaise
- Cold dishes, particularly if served on crushed ice
- Any cooked food that has cooled; dishes should be consumed piping hot, immediately after they’ve been cooked
- Any food left to stand at room temperature
How to purify water when travelling
Commercially sold (sealed) bottled water is the safest option for travellers. However, if you do not have access to bottled water, there are several ways you can treat water:
- By boiling it for at least 15 minutes
- By purifying it using hydroclonazone tablets, available in pharmacies (e.g., Micropur®, Aquatabs®)
- By using a water purification system, which can be purchased in certain sports and outdoor equipment stores (e.g., Katadyn®)
Avoid traps
A very small quantity of water containing pathogenic agents suffices for contracting travellers’ diarrhea. In addition to the aforementioned precautions, take the following as well:
- Watch out for cocktails, smoothies and shakes. It is easy to forget that the ice or juice used to make them contains untreated water.
- Do not brush your teeth using tap water. Here’s a trick to help you remember: keep a bottle of water ready to use next to your toothbrush.
- While showering, taking a bath or swimming, avoid letting water into your mouth.
- Avoid contact with anyone who is sick. Turista is transmissible from person to person.
Tip #4: Know what to do in case you catch traveller’s diarrhea
The cornerstone of turista treatment is proper hydration. And although this alone can suffice in most cases, it may be advisable to take medication in more worrisome situations.
Rule #1: Hydration, hydration, hydration
Whether your symptoms are mild or severe, it is crucial that you maintain or replenish your body’s hydration by drinking large quantities of liquids. In light cases of turista, plain water will generally do the trick. Make sure, of course, to drink water that is safe.
Oral rehydration solutions for traveller’s diarrhea
In cases where water is not tolerated by the patient and in cases of moderate-to-severe turista, an ORS, or oral rehydration solution (e.g., Gastrolyte®), which contains minerals essential for the body to function properly and that promotes the absorption of water, can be a lifeline.
An ORS can be purchased at the pharmacy, whether bottled or in packets that are easy to pack in your luggage and then dissolve in safe water if needed.
Home remedies as a last resort;
Homemade oral rehydration solutions are not recommended due to the fact that it is difficult to obtain efficient, safe and precisely measured concentrations of mineral salts and glucose. Homemade oral rehydration solutions must be used with caution and only when there is no way of securing a commercially sold ORS.
Use medication as prescribed
Prior to your departure, make sure that you have a clear understanding of how to use the various medicines you are packing. In case of any doubt, ask your questions to your pharmacist or doctor, that way you will know how to proceed if a problem comes up.
Always follow the specific instructions on how to use each medication, as well as your pharmacist’s or doctor’s recommendations to the letter. Below are the basic principles.
How to proceed in cases of mild traveller’s diarrhea?
Diarrhea is considered mild if it is tolerable and does not interfere with planned activities. Mild symptoms usually subside on their own and do not require any particular treatment.
If, however, the urge to use the restroom is too frequent or you do not have easy access to a toilet (during transit, for example), the following anti-diarrheals may be used:
- Bismuth subsalicylate (e.g., Pepto-Bismol®)
- Loperamide (e.g., Imodium®)
Antibiotics are not recommended in cases of mild diarrhea.*
How to proceed in cases of moderate traveller’s diarrhea?
Diarrhea is considered moderate when its intensity is sufficient to interfere with planned activities. For self-treatment of moderate diarrhea, the use of loperamide (e.g., Imodium®) as monotherapy is recommended, i.e., not in combination with any other drug.
Antibiotics are not recommended* in cases of moderate diarrhea, except under certain medical conditions, e.g., in cases of renal or cardiac insufficiency (kidney or heart failure).
* Why limit the use of antibiotics for traveller’s diarrhea treatment?;
The use of antibiotics is associated with a greater risk of severe diarrhea linked to the Clostridium difficile bacterium or multidrugresitant bacteria. Furthermore, the use of antibiotics contributes to increased bacterial resistance globally. For that reason, the use of antibiotics in cases of traveller’s diarrhea should only be considered if and when initial efforts fail or if symptoms worsen.
How to proceed in cases of severe traveller’s diarrhea?
Severe diarrhea is incapacitating and disrupts planned activities entirely. Any form of dysentery (bloody diarrhea) is considered severe. If symptoms are serious, it’s time to use the antibiotics that were prescribed to you.
If you haven’t already, also take loperamide (e.g., Imodium®) in conjunction with antibiotics.
Caution: In cases of bloody diarrhea or fever, anti-diarrheal medicines are contraindicated. See your healthcare professional for further information;
Start eating again as soon as possible, with caution
While traveller’s diarrhea does disrupt the absorption of nutrients, contrary to popular belief, it is not recommended to forego food completely.
Swift reintroduction of foods does not appear to be harmful. On the contrary, nutritional intake can contribute to a person’s recovery from traveller’s diarrhea.
Until the gastrointestinal system of an affected person regains its balance, foods that are rich in fat must be avoided as they can hinder digestion and exacerbate diarrhea. It is recommended to eat a diet consisting of easy-to-digest foods, such as:
- Rice
- Pasta
- Semolina
- Well-cooked carrots
- Other foods that are easily digested
Tip #5: Recognize emergency cases
Although traveller’s diarrhea is a temporary issue that is not serious in most cases, complications, on the other hand, must be taken seriously. Dehydration can have serious consequences and can even lead to death.
When to see a doctor for traveller’s diarrhea
The following symptoms are signs that a doctor’s assistance is urgently needed:
- Severe diarrhea that hasn’t subsided after 24 to 48 hours of antibiotic treatment
- The presence of blood in the stool
- High fever (39 °C and above)
- Intense abdominal pain
- Profuse sweating
- Persistent vomiting
- Signs of severe dehydration:
- Dry mouth
- Reduced thirst
- Reduced sweating
- Reduced skin elasticity
- Reduced urine production and urine that is unusually dark yellow
- Dizziness
- Confusion
- A generally worrying state of being
Caution: Travellers in malaria-risk zones
Symptoms of malaria may resemble those of traveller’s diarrhea. When symptoms are accompanied by fever, see a doctor immediately, making sure to mention the place you visited in order to either rule out this diagnosis or to act quickly.
If you are travelling to a place that is affected by malaria, ask your pharmacist about malaria prevention treatment.
People at risk of developing complications
Particular attention must be paid to more fragile individuals who can develop dehydration more quickly, or in whom dehydration can prove more difficult to detect:
- Children, particularly babies and toddlers
- The elderly
- People suffering from chronic illnesses
- People with a weakened immune system
Be alert and have a safe trip!
There are, of course, many things to take into consideration before and during your travels. However, by having a good understanding of traveller’s diarrhea, being cautious and knowing what to do in case of a problem, you can enjoy your trip to the fullest.
Schedule an appointment with your pharmacist affiliated with Accès pharma chez Walmart and enjoy custom professional coaching for your travel health-related plans.
Your pharmacist affiliated with Accès pharma wishes you a good trip in good health!;
Sources
- Government of Canada, Travellers’ diarrhea
- Merck Manual, Consumer Version, Traveler’s Diarrhea (Turista)
- Institut national de santé publique du Québec, Information about Travelers’ diarrhea
- Passeport Santé, Qu’est-ce que la turista?
