Prevention and Treatment of Travelers Diarrhea

Most travelers dread the prospect of diarrhea. It usually results from contaminated food or water, occurs in up to 60% of travelers and often lasts 3 to 7 days if untreated. Although digestive upsets occur in travelers because of stress, time zone changes, irregular meal times and unfamiliar foods, serious diarrhea is caused by bacteria, viruses or parasites and is much more frequent in developing countries. It is difficult to guarantee absolute food and water safety but careful choices and consistent hand washing markedly reduce risk.



-Pick your eating places carefully--a good reputation with travelers sometimes helps

-Choose food that is well cooked and served hot

-Baked goods like tortillas, crackers, bread are often low risk

-Fruits and nuts with thick skins/shells you remove yourself are OK--eg. oranges, bananas

-Canned foods are usually safe


-Street vendors and market stalls

-Raw, undercooked, cold meats, seafood, fish

-Salads, uncooked vegetables, berries

-Cold sauces like mayonnaise, salad dressing, uncooked salsa

-Unpasteurized dairy products--milk, yogurt, cheese, ice cream, custards

-Buffets where foods may sit for long periods of time and be reheated



-Bottled water from reliable sources with seals intact--international brands may be safest

-Water that has been boiled, even for a minute at any altitude, or chemically treated

-Canned or commercially bottled carbonated water or soft drinks

-Coffee, tea, beer, wine

-Brush your teeth with bottled or safe water

-Breast feeding is safest for infants still nursing--make formula with safe water and sterilized bottles.


-Tap water--even if chlorinated or from the hot water tap should be considered unsafe

-Ice unless made with boiled, bottled or purified water

-Fruit juice unless from a can--they are often diluted with tap water

-Water in your hotel room in an unsealed bottle or carafe labeled “Bottled Water”

-Rinsing your toothbrush with tap water

-Alcoholic beverages made with ice or tap water--the alcohol doesn’t kill bacteria, it just makes them tipsy

-As a rule, EVERYTHING in developing countries is watered down with tap water--even the watermelon has water injected into it to make it heavier.


Filters: Portable water filters, pumps, filter bottles etc. are not absolutely proven to be effective. Filters with a pore size of 0.2 microns or less will reduce the number of organisms in water but the water should still be boiled or chemically treated.

Boiling: Bringing water to a boil at any altitude will make it safe.

Chemical disinfection:

-Iodine based water purification tablets are available

-Tincture of Iodine 2%--add 5 drops to a liter of water and let stand for 30 minutes

-Iodine products should NOT be used by pregnant women, persons with thyroid problems or iodine allergies

-Chlorine dioxide 


Diarrhea in travelers is most frequently caused by bacteria and sometimes by parasites, eg. Giardia or occasionally by viruses. How do you tell the difference? Sometimes lab tests are the only way but usually bacterial diarrhea has a sudden onset while that caused by parasites has a slower, gradual onset.

The most important thing to do when diarrhea strikes is stay well hydrated. Water, juice or oral rehyration solution are suitable. ORS is available in many countries as packets of mix or sometimes as bottled solutions. Healthy Traveler Clinic and our online travel supply store stocks ORS mix as well as Ceralyte® which is more palatable. Of course, make sure any water you drink or mix your rehydration mixture with is safe.

Since diarrhea is usually bacterial, the use of appropriate antibiotics often markedly shortens the illness. Generally, fluoroquinolone antibiotics like ciprofloxacin, norfloxacin, ofloxacin or levofloxacin are recommended. Some areas of the world such as southeast asia require a different antibiotic-- azithromycin because of resistant bacteria. Healthy Traveler Clinic offers prepackaged antibiotic diarrhea kits that are convenient and compact.

If diarrhea is severe or accompanied by fever, blood or mucus in stools or lasts longer than 2 or 3 days, seek medical help.


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