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Summer is traveling season. . . this brings up the age-old question of … What to do to avoid diarrhea?  What to take?  When to take it?

What is traveler’s diarrhea?  It is defined as passing 3 or more loose stools in 24 hours with accompanying symptoms of fever, nausea, vomiting or cramps.  60-70% of travelers from developed countries to less-developed countries may contract TD.

The travel destination is important.  There are parts of the world that are “very high” risk of contracting TD (South Asia) ranging to “low” risk like Europe, Australia and Northeast Asia.

Dietary choices are also important.  The least risk is business travelers and tourists who only eat/drink in more affluent settings where preparation may be more hygienic.  “Boil it, peel it, or forget it” may be a good mantra.  The older a traveler is, the lower the risk of TD.  Patient factors that increase risk of TD are use of proton pump inhibitors and immunocompromised travelers.

Who should take antibiotics while on vacation?  It is recommended that antibiotics be given for travelers at high risk for travelers’ diarrhea and those at high risk for complications if they contract it.  There is also a softer indication (meaning your physician will probably give you the medicine) if you have an inflexible itinerary.

What to take?  Antibiotics (1 to 3 days’ worth) will help.  Loperamide is an antimotility agent which helps decrease diarrhea.  This is used in addition to antibiotics, but not used to treat children.

How long does TD last?  It usually starts 1-2 weeks after arrival and lasts no longer than 4 to 5 days.  If symptoms last longer, then further work up is needed.