HEALTH TIPS

Healthy Lifestyle Tips

• Whenever a person travels from one country to another - particularly if the change involves a marked difference in climate, social conditions, or sanitation standards and facilities - diarrhea is likely to develop within 2 - 10 days.  There may be up to ten or even more loose stools per  day, often accompanied by abdominal cramps, nausea, occasionally vomiting, and rarely fever. The stools  do not usually contain mucus or blood, and aside from weakness dehydration there are no systemic manifestations of infection. The illness usually subsides spontaneously  within 1 - 5 days. Although 10% remain symptomatic  for a week or longer, an din 2% symptoms persist for  longer than a month. 

  Bacteria cause 80% of cases of traveler's diarrhea, with enterotoxigenic E coli, shigella species, and campylobacter jejuni being the most common pathogens. Less common causative agents include aeromonas, salmonella, noncholera vibrious. Entamoeba histolytica, and Giardia lamblia. Contributory causes may at times include unusual food and drink, change in living habits, occasional viral infections, and change in bowel flora. In patients with fever and bloody diarrhea, stool culture may be indicated, but in most cases cultures are reserved for those who do not respond to antibiotics. Chronic watery diarrhea may be due to amebiasis or giardiasis or, rarely, tropical sprue.
  

  For most individuals, the affliction is short-lived, and symptomatic therapy with opioids or loperamide is all that is required provided the patient is not systemically ill and does not have dysentery, in which case antimotility agents should be avoided. Packages of oral rehydration salts to treat dehydration are available over the counter in the USA and in many foreign countries. Avoidance of fresh foods and water sources that are likely to be contaminated is recommended for travelers to developing countries, where infectious diarrheal illnesses are endemic. Prophylaxis is remended for those with significant underlying disease and for those whose full activity status during the trip is so essential that even short periods of diarrhea would be unacceptable. Prophylaxis is started upon entry into the destination country and is continued for 1 or 2 days after leaving. For stays of more than 3 weeks, prophylaxis is not recommended because of the cost and increased toxicity. For prophylaxis, bismuth subsalicylatseffective but turns the tongue and the stools black and can interfere with doxycyline absorption, which may be needed for malaria prophylaxis. Numerous antimicrobial regimens for once-daily prophylaxis also are effective, such as n orfloxacin 400 mg, ciprofloxacin 500 mg, lfloxacin 300 mg, or trimethoprim - sulfamethoxazole 160/80 mg. Because not all travelers will have diarrhea and because most episodes are brief and self-limited, an alternative approach that is currently recommended is to provide the traveler with a supply of antimicrobials to be taken if significant diarrhea occurs during the trip. Loperamide with a single dose of ciprofloxacin, or olfloxacin cures most cases of traveler's diarrhea. If diarrhea is severe, associated with fever or bloody stools, or persists despite single-dose ciprofloxacin treatment, then 3 - 5 days of ciprofloxacin 500 mg twice daily, levofloxacin 500 mg once daily, norfloxacin 400 mg twice daily, or ofloxacin 300 mg twice daily can be given. Trimethoprim-sulfamethoxazo l60/800 mg twice daily can be used as an alternative, but resistance is common in many areas.