It’s the CCFP SOO exam – you’re about to enter the next station … Your station has a 23-year-old male coming in for travel advice. He is going to Jamaica and wants to know what he can do to prevent getting traveller’s diarrhea. What are you going to ask? Are you confident about what medications he needs? What investigations may be needed once the patient has returned home if the symptoms persist?

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This blog is a summary of the Canadian Family Physicians’ article on traveller’s diarrhea. The article can be found here.

“Doc, what is traveller’s diarrhea?â€

Traveller’s diarrhea (TD), the quick onset of loose or liquid stools during travel, is a prevalent problem that can impact your travel plans. TD occurs when travellers consume food or beverages that are contaminated, typically by a bacteria pathogen (e.g., enterotoxigenic Escherichia coli, enteroaggregative E. Coli, or Campylobacter).

“Doc, what symptoms should I watch out for?â€

Symptoms can include cramps, stomach pain, urgent stools, fever, vomiting, and dysentery (bloody diarrhea). They tend to last 2-4 days.

“What steps can I take to reduce my risk?â€

You can advise the following:

• Frequent handwashing with either soap or sanitizer
• Eating only foods that are fully cooked and still hot
• Using bottled water to drink and to brush teeth
• Avoiding ice cubes, salad, and raw vegetables
• Eating only fruits that can be peeled (peel your own fruit)
• Taking bismuth subsalicylate 4x per day during travel (if desired/necessary)

Tell the patient to pack the following:

• Oral rehydration solution (e.g., Gastrolyte)
• Loperamide (e.g., Imodium)
• An antibiotic (e.g., Azithromycin)

“Okay Doc, I will pack what you suggested. When do I take these medications?â€

• If you have diarrhea, start the oral rehydration right away
• Take loperamide for mild, moderate, or severe diarrhea (do not take if you have bloody diarrhea)
• Take antibiotics for moderate or severe TD
• Seek medical attention for TD that doesn’t improve within 24-36 hours

“What happens if my symptoms persist despite your recommended treatments?â€

• Up to 10% of those who get TD suffer from complications
• You may need stool testing for severe diarrhea or symptoms that last > 2 weeks
• In rare circumstances, you may need a colonoscopy to diagnose a post-infectious colitis
• You may experience joint pain and muscle weakness – you should be aware of rare but serious complications such as reactive arthritis and Guillain-Barré syndrome

Written by Maria Veinberg. Reviewed by Dr. Prokubovskaya & Dr. Premji.