Most traveler’s diarrheas are caused by infections with particular strains of E. coli bacteria, which produce toxins that cause fluid secretion by the bowel. Almost all of the diarrheal illnesses caused by these common microorganisms are “self-limited” – that is, they will go away by themselves without any antibiotic treatment. Relatively few of those who develop diarrhea in foreign countries are infected with parasites, protozoa’s, or other dangerous microorganisms.
So, how can these intestinal infections be prevented?
Taking medications preventatively is not usually recommended. Antibiotics, like doxycyline, taken before any symptoms ever show up, promote the tendency of the diarrhea bacteria to develop resistance to antibiotics. Besides, there is always the chance of experiencing possible side effects of the drug, which can include gastrointestinal upset, as well as sunlight hypersensitivity! Large doses of Pepto-Bismol taken preventatively have been shown to work about 75% of the time, but this tactic might prove unreasonable. The required dosage is 30 ml. (1 oz.) every half hour for eight doses per day! This comes out to seven -8 oz. bottles for a weeks stay!!!!
What is recommended as preventative measures against “Montezuma’s Revenge” is a number of practices; all resting on the premise that thorough cooking destroys all of the various infectious agents. With this in mind, avoid all water and ice cubes (except for purified bottled water - this includes water used in brushing your teeth). Also avoid milk, coffee (except if it’s steaming hot), salads, all raw fruits and vegetables (unless you peel them yourself), and all cooked foods held at room temperature. Unfortunately, salsa sitting out on the table is a great way to get diarrhea also.
If you do end up contracting a case of diarrhea, check your stools. If they are watery and brown, it’s probably an E. coli infection and is probably self-limiting and will go away on its own within a week. You could take 4 oz. of Pepto-Bismol, all at once, daily for 2 days, to help solidify your stools and decrease your cramps. Pepto-Bismol will darken your stools until they look almost black. This is normal and no cause for alarm. Pepto-Bismol can be bought in Mexico but must be shaken up vigorously before taking.
Meanwhile, if you develop serious abdominal cramps, bloody stools as black as tar with a fever, or severe diarrhea and vomiting, you could have a more serious infection that would warrant medial attention. One treatment plan in this case includes Septra or Bactrim DS, taken twice daily for 5 days. (NOTE: these drugs are SULFA drugs, which can cause serious allergic reactions in some people—usually a skin rash. If you take this medicine and develop a rash or other possible side effects, discontinue it immediately!). In the serious type of diarrhea, Lomotil is not recommended. Your body is trying to rid itself of the infecting organism and if you try interfering with this process by taking Lomotil, more serious complications could develop and your illness might be prolonged.
Before you do leave town, you should learn how to take care of yourself just in case you get the “Revenge”. Of prime importance – put your stomach to rest and increase your fluid intake. Drink any and all clear liquids, including water, broths and gelatin. Avoid all milk and dairy products, as these can worsen diarrhea. Avoid all solid foods completely. When you start feeling stronger, eat only foods such as bananas, plain tortillas, rice, rice cereals and breads. Continue to force clear fluids until you are feeling well. Start eating solid foods again when your system feels up to it. If your diarrhea doesn’t improve after one week of self-care, you should seek professional treatment.
Have a fun trip and don’t forget about sunburn self-care either! If you
have any further questions, stop in at the Campus Health Center and we’ll try
to answer them for you. You can also get more information at: www.cdc.gov/travel/index
- the CDC’s health web site.