Travel to Developing Countries - Traveler's Diarrhea

Helpful Foods. Foods that help slow diarrhea include rice, wheat, bananas, salted crackers, and mashed potatoes.

Contrary to popular advice, adding some milk (but not soymilk) to these foods may help many children. In fact, eating yogurt that contains active lactobacilli cultures may have positive benefits. (However, yogurt drinks in less developed countries may carry a high risk for contamination.)

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Bismuth subsalicylate (Pepto-Bismol). Pepto-Bismol can be used for treatment, as well as prevention, for diarrhea. Treatment generally consists of 1 fluid ounce or 2 tablets every 30 minutes for up to 8 doses in a 24-hour period. If diarrhea continues, treatment can be repeated for a second day.

Antimotility Drugs. Antimotility drugs provide prompt but temporary symptomatic relief by reducing muscle spasms in the gastrointestinal tract. They include:

Loperamide (Imodium)
Diphenoxylate (Lomotil)
Opiates (such as paregoric, tincture of opium, and codeine)

Antimotility drugs should be discontinued if symptoms persist beyond 48 hours and should not be used at all:

In patients with high fever
If there is blood in the stool
In children under the age of two

Imodium is approved for children 2 years or older, but its use in children is controversial because of reports of severe side effects. Experts do not recommend it.

Note. Lomotil and Imodium work well for treating diarrhea, but are not effective for prevention. Lomotil may even increase the risk for it.

Antibiotics. Antibiotics are generally effective for treating traveler's diarrhea that develops in an 8-hour period, with three or more loose stools, and especially if associated with nausea, vomiting, abdominal cramps, fever, or blood in the stools. Because antibiotics are prescription drugs, travelers at risk should obtain them before they depart and should receive directions for self-treatment while abroad. Antibiotics should not be used for nausea and vomiting when diarrhea is not present. Although self-treatment is generally safe, a doctor should be sought for any child with diarrhea and for adult patients who develop fever or bloody diarrhea. (Antibiotics are generally not useful for diarrhea in developed nations, since such cases are likely to be caused by viruses.)

In general, patients take one tablet every 12 hours for 5 days. Taking a single dose of an antibiotic such as ofloxacin (Floxin), plus an antimotility drug (usually Imodium), often provides relief within 24 hours for many patients. Other antibiotics used for diarrhea include ciprofloxacin (Cipro), rifaximin (Xifaxan), levofloxacin (Levaquin), and azithromycin (Zithromax).