Travelers’ Diarrhea

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Travelers’ Diarrhea Defined, Symptoms, & Treatment Options

This information is intended for U.S. residents only.

What is travelers’ diarrhea?

People get travelers’ diarrhea by eating food and drinking water that contain germs. People can get this illness in areas of the world where the drinking water is not clean.

Most travelers’ diarrhea cases begin abruptly. Usually, a traveler experiences four to five loose or watery bowel movements each day. Other common symptoms include nausea, vomiting, diarrhea, abdominal cramping, bloating, fever, urgency, and malaise.

How common is travelers’ diarrhea?

Twenty to 50% of travelers may develop diarrhea depending on the region of the world they visit. In fact, diarrhea is the most common illness of travelers. Men and woman are at equal risk for developing travelers’ diarrhea. In general, travelers at risk for diarrhea commonly come from industrialized nations and travel to high-risk areas that are primarily within developing or less industrialized nations of the world, including Latin America, Africa, the Middle East and Asia. Areas of lesser risk include China and some Caribbean nations. Travel to areas of the United States, Canada, Northern Europe and Australia pose the lowest risk to travelers.

Risk areas for travelers’ diarrhea

Click here to download the map (PDF 2.6MB)

What are the symptoms of travelers’ diarrhea?

The symptoms of travelers’ diarrhea vary. Generally, diarrhea occurs within the first week of travel and lasts up to 3-4 days.

Treatment of travelers’ diarrhea

For patients diagnosed with travelers’ diarrhea, oral rehydration is often beneficial to replace lost fluids and electrolytes. Additionally, certain patient may benefit from antibiotic therapy usually given for 3-5 days. Antimotility agents can also be used to treat the symptoms of travelers’ diarrhea.

How does travelers' diarrhea affect gut flora imbalance?

Travelers' diarrhea is caused by pathogenic bacteria (eg, E. coli ) displacing healthy gut flora. The resulting pathogenic infection can cause mild or severe inflammation of the gastrointestinal epithelium.1,2 The inflammation can disrupt the delicate balance between epithelium and gut flora.1 In some cases of travelers' diarrhea, this imbalance has been shown to lead to chronic gastrointestinal illness.1,3

How do conventional systemic antibiotics affect gut flora?

Conventional systemic antibiotics are effective in travelers' diarrhea, but can also cause disruptions to gut flora.4-6 These disruptions can be short- or long-term, with clinical studies showing that disruptions can last for up to 2 years.7,8

References

1. Okhuysen PC. Travelers' diarrhea, new insights. J Clin Gastroenterol. 2007;41(suppl 1):S20-S23.
2. Acute diarrhea. Cleveland Clinic. http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/gastroenterology/acute-diarrhea. Accessed August 6, 2009.
3. Okhuysen PC, Jiang ZD, Carlin L, Forbes C, DuPont HL. Post-diarrhea chronic intestinal symptoms and irritable bowel syndrome in North American travelers to Mexico. Am J Gastroenterol. 2004;99:1774-1778.
4. Huang DB, DuPont HL. Rifaximin—a novel antimicrobial for enteric infections. J Infec. 2005;50(2):97-106.
5. Okhuysen PC. Current concepts in travelers' diarrhea: epidemiology, antimicrobial resistance and treatment. Curr Opin Infect Dis. 2005;18:522-526.
6. Preidis GA, Versalovic J. Targeting the human microbiome with antibiotics, probiotics, and prebiotics: gastroenterology enters the metagenomics era. Gastroenterology. 2009;136:2015-2031.
7. Phillips ML. Gut reaction. Environmental effects on the human microbiota. Environ Health Perspect. 2009;117(5):A199-A205.
8. Jernberg C, Lofmark S, Edlund C, Jansson JK. Long-term ecological impacts of antibiotic administration on the human intestinal microbiota. ISME J. 2007;1(1):56-66.

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