Travel to Developing Countries - Traveler's Diarrhea

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Preventive Drugs

There is no vaccine against traveler's diarrhea. However, vaccination against cholera has been shown to offer some protection against TD in 25% of travelers.

The following drugs can reduce your chance of getting sick:

Pepto-Bismol. 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. Both aspirin and Pepto-Bismol share the active ingredient salicylate, which can be harmful to children. Many medications interfere with salicylate, and people who are allergic to aspirin, pregnant women, and those who have ulcers, other bleeding disorders, or gout, should not take Pepto-Bismol without consulting a doctor. Side effects of Pepto-Bismol include ringing in the ears and black stools and tongue.

Prophylactic Antibiotics. Prophylactic antibiotics are those used to prevent diarrhea while traveling. They work well, but there are many reasons that argue against their routine use. Taking prophylactic antibiotics can trigger adverse drug reactions, development of superinfections, and can contribute to bacterial resistance. Antibiotics are also not effective against parasites or viruses and may give travelers a sense of false security. At this time, prophylactic antibiotics are not generally recommended unless the person is at increased risk for complications of TD, including people with chronic bowel diseases, kidney disease, diabetes, or HIV.

Researchers are studying whether prophylactic antibiotics should be used more often. In a 2005 study of travelers to Mexico, 15% of patients who took preventive doses of the antibiotic rifaximin (Xifaxan) developed traveler’s diarrhea compared with 54% of patients who received placebo (sugar pill). Rifaximin was approved in 2004 for treatment of diarrhea caused by E. coli.

Lactobacilli. Taking capsules that contain protective bacteria called lactobacilli (also called probiotics), may be helpful, although the Infectious Diseases Society of American believes that evidence is insufficient to recommend them. Some studies report that a genetically engineered strain called Lactobacillus rhamnosus strain GG may prevent and reduce severity of diarrhea. In fact, lactobacilli may be used for both prevention and treatment in children without any adverse effects. The capsules can be split open and put into beverages for small children.