International SOS



Avoiding Traveler’s Diarrhea

Risk of getting traveler’s diarrhea is not the same in every country, or in different areas of the same country.

High-risk areas include most of Asia, the Middle East, Africa, Mexico, and Central and South America.

Intermediate-risk areas include those in Eastern Europe, South Africa, and some of the Caribbean islands.

Low-risk areas include the United States, Canada, Australia, New Zealand, Japan, and countries in Northern and Western Europe.

Preventative Measures:

To avoid illness, travelers should be advised to select food with care.

Water: Don’t drink tap water. Use bottled or canned water, or beverages. (This also applies to brushing teeth, rinsing mouth, etc.) If you are buying a water filter or purifier, buy one that can filter out organisms as small as those that cause giardiasis, cholera, and amoebic diarrhea.

Ice: Avoid putting ice in water/beverages.

Alcoholic Beverages: Mix only with bottled or canned water; do not use ice.

Coffee and Tea: Safer with bottled water or if water is brought to a full boil and used immediately.

Dairy Products: Not pasteurized in some parts of the world; if in doubt, avoid dairy products.

Salads: Raw food washed in tap water is not always safe; it is best to avoid these.

Sauces and Dressings: Best to avoid since ingredients are often unknown.

Fresh Fruits: Safest when completely peeled, by you. Avoid if washed in tap water or meant to be eaten unpeeled.

Raw/Uncooked Foods: Best to avoid.

Street Vendor Foods: Avoid.

Breads: Usually safe if recently baked.

Basic Rules: Boil it, cook it, peel it, or forget it. Only eat food that has been cooked well and is still hot.

More info at

Travelers are advised to avoid salads, uncooked vegetables, and unpasteurized dairy products. Only eat foods that have been cooked well and are still hot, or fruit that has been peeled by the traveler personally. Undercooked and raw meat, fish, and shellfish can carry various intestinal pathogens. Some species of fish and shellfish can contain poisonous biotoxins, even when well cooked. Barracuda, Red Snapper, Grouper, Sea Bass, and Bottom-dwelling fish can contain such toxins.

Water that has not been chlorinated properly can harbor enteric viruses and parasites. It is recommended to only drink bottled or canned beverages. Do not accept containers that have already been opened, and always dry the outside of the container if wet.

Treatment:

Ciprofloxacin information and dosage

If the traveler becomes ill and experiences 3 or more loose stools within an 8 hour period (particularly associated with nausea, vomiting, high temperature and/or blood in the stool), begin taking ciprofloxacin 500mg twice a day for 3 days. Take it for the full 3 days. It may be taken with or without meals, but the preferred dosing is 2 hours after a meal. If severe diarrhea persists after 3 days, stop taking ciprofloxacin and seek medical care.

Do not take ciprofloxacin with dairy products, antacids containing aluminum, magnesium, or calcium, or multiple vitamins containing iron or zinc. Avoid excessive exposure to sunlight and artificial light. If sunlight cannot be avoided, wear sunscreen and a hat. Ciprofloxacin may cause dizziness and lightheadedness. Use care in operating a car or other machinery.

Loperamide information and dosage

The International Travel Kit provides loperamide, which is the generic for the brand Imodium and is the same as Imodium AD (OTC). Loperamide provides prompt relief of uncomplicated, acute, nonspecific diarrhea. The recommended dose is 2 capsules after each loose stool, not to exceed 8 capsules in a 24 hour period.

Loperamide should not be taken with high fever, blood in the stool, or for more than 48 hours if diarrhea persists. It should not be administered to children under the age of 2.

Side effects of loperamide are generally minor. They include abdominal pain and distension, nausea, vomiting, constipation, dry mouth, and drowsiness. Loperamide and ciprofloxacin may be taken together in certain cases.

Malaria

Malaria is a serious parasitic infection transmitted to humans by mosquitoes throughout the entire tropical world. Symptoms include high fever and flu-like symptoms, including chills, headache, muscle aches, and tiredness. If left untreated, malaria can cause anemia, kidney failure, coma, and death.

Highest risk regions for infection are West Africa and Oceania.

Moderate risk regions for infection are other parts of Africa, South Asia, and South America.

Lower risk regions are other parts of Asia and Central America.

Be aware that the risk of infection varies country-by-country and within different regions of the same country.

Preventative Measures:

All travelers to the tropics should use an appropriate prophylactic drug and personal protective measures to prevent malaria. However, in spite of all protective measures, travelers occasionally develop malaria. While traveling and up to one year after returning home, travelers should seek medical evaluation immediately for any flu-like illness. Travelers who have symptoms of malaria should be advised to seek medical evaluation as soon as possible.

Mosquito Avoidance Measures

Always practice the following measures. Remain in well screened areas from dusk to dawn, using (insecticide-treated) mosquito bed nets and pyrethroid-containing flying insect spray. All travelers should wear clothes that cover most of the body and use an effective insect repellent. For added protection, sleeping quarters can be sprayed with a permethrin fogger, and clothes can be sprayed with permethrin spray. Use repellent with 30-35% or less concentration of DEET on any exposed skin. Some examples of effective repellents:

|Product |DEET Concentration |

|3M UltraThon Insect Repellent |34.34% |

|Sawyer Premium ULTRA 30 |30% |

|Ben’s 30% DEET Spray Pump |30% |

|Off! Deep Woods Insect Repellent |25% |

|Cutter Back Woods Insect Repellent |23% |

*WARNING: Read product instructions carefully for application and reapplication. Do not use a product containing greater than 35% DEET.

Prophylactic Drug Information

Aralen (Chloroquinine)

Aralen is the drug of choice for preventing malaria when traveling to Mexico, the Dominican Republic, Haiti, Central America, the Middle East, and North Africa. Aralen is taken weekly (on the same day each week), beginning 1-2 weeks prior to travel, continuing during the time spent in the malarious area, and 4 weeks after returning from the trip. Aralen can cause minor side effects including gastrointestinal disturbance, dizziness, headache, blurred vision, and itching.

Lariam (Melfoquine)

Lariam is the drug of choice for preventing malaria in countries where malaria is resistant to Aralen, including Southeast Asia, sub-Saharan Africa, the Amazon region of Brazil, Oceania, India, Pakistan, Papua New Guinea, and in Sumatra and Irian Jaya in Indonesia. Lariam is taken weekly (on the same day each week), beginning 1-3 weeks prior to travel, continuing during the time spent in the malarious area, and 4 weeks after returning. Always take Lariam with food and water.

Lariam can cause side effects of gastrointestinal disturbance, dizziness, or nausea. Prolonged exposure to sunlight should be avoided when taking Lariam. Lariam cannot be taken by children ................
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