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Montezuma’s Revenge: Understanding and Preventing Traveler’s Diarrhea

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Paula Monte a Physician Assistant at the Vanderbilt Travel Clinic speaks with Teera Wilkins about traveler’s diarrhea. Paula, talks about the dos and don’ts when traveling to an under-developed country.

Traveling internationally for Vanderbilt business? Occupational Health Clinic offers free pre-travel consultations and customized healthcare plans, including travel vaccinations. Schedule your exam now.

Begin Transcript

Teera Wilkins:          Welcome to this edition of the Vanderbilt University Health and Wellness Wellcast.  I am Teera Wilkins with Occupational Health Clinic.  Hi, I am here today with Paula Monte a Physician Assistant at the Vanderbilt Travel clinic.  How are you doing Paula?

Paula Monte:            Good, thanks.  How are you doing?

Teera Wilkins:          Doing pretty good.  Summer months are approaching and some of our employees may be traveling out of the country for either business or personal usage.  One of the big scares is traveler’s diarrhea.  What causes traveler’s diarrhea?

Paula Monte:            Traveler’s diarrhea is caused by organism mostly bacterial, but we do see some protozoa and viral suspects causing traveler’s diarrhea, but the majority of the cases that we see are bacterial.

Teera Wilkins:          What are ways to avoid?

Paula Monte:            Traveler’s diarrhea is picked up by contaminated food and water and people handing your food and water.  So, in under-developed countries, we would see this in restaurants, market places, market stalls, people who are eating off the street as we say, people who are eating in locally  owned and operated  restaurants that is where we see the majority of the cases.  Many people traveling to under-developed countries who can seek out and find high end restaurants catering to westerners, they are at a lower risk of contracting traveler’s diarrhea.  So, the two culprits that we can prevent travelers from being exposed to and becoming ill from are typhoid fever and hepatitis A; we have vaccines for those.  We also recommended they carry over‑the‑counter Imodium.  Imodium is a medicine used to stop the motility of the colon which decreases the diarrhea, and there is a place for that.  If a traveler has mild diarrhea possibly a few loose bowel movements without any other symptoms meaning no cramping and no nausea.  No fever or chills.  We always recommend they try Imodium first.  If they fail Imodium, they have that backup antibiotic prescription.  The biggest “Don’t’s”, do not eat street food.  Do not eat anything that looks raw, under-cooked, or served cold that includes vegetables and fruits.  Do not eat fresh fruits and vegetables.  Cream sauces are no-no.  Condiments, sauces, chutneys; be very careful with those because they are usually made from fresh fruits and vegetables.  Ice is a big one.  Tap water, of course, fresh fruit juices are another culprit that I hear a lot of complaints about.  So, you want to stay away from those things.  The do’s, the things that you can be comfortable eating are cans and bottles of beverages that have not been tampered with and wipe off the mouth piece.  If there is water on that mouth piece, the water is probably contaminated.  Anything served hot and brew; coffee, tea, fine to drink.  Any food served hot and well-cooked, fine to eat.  Any nonperishable; bread, tortes, biscuits, crackers, canned vegetables; they are all fine to eat, dry fruits and nuts are fine to eat.

Teera Wilkins:          Can you get it from just swallowing regular shower water?

Paula Monte:            Yes, you can, and I always recommend and advise my clients to not trust water coming through faucet.  So, I recommend they not stick their toothbrush under it, not use it to rinse out their mouth and keep their mouth closed in the showers.  It takes one drop of contaminated water to make you ill, and this is really important when traveling with children who like to stick their wet fist in their mouth, their wet toys, and wet hair dripping in their mouth.  I always caution them to be very careful in hotels where they are not sure what that water quality is.

Teera Wilkins:          You said that there is antibiotics.  Are there preventative medicines? There is no preventative medicine, right?

Paula Monte:            We do not recommend that the patients take something to prevent them from becoming ill.  Some people do think probiotics have a place in preventing traveler’s diarrhea.  I have not seen any strong scientific data supporting that, and then there are some clients who have been told that taking Pepto-Bismol can prevent traveler’s diarrhea.  Again, there is no strong scientific data supporting that.  I know that there are people out there doing it, having success and that is great, good for them, but they do have to understand especially with the Pepto‑Bismol.  Pepto-Bismol is salicylate bismuth which if taken too much of can have side effects.  So, I do caution our clients to keep that in my mind if that is something that they want to do, they should really check with the primary care provider before they do that.

Teera Wilkins:          Do you usually only prescribe antibiotics in severe cases?

Paula Monte:          All of my clients traveling to under-developed countries, I gave them an antibiotic prescription to fill and carry with them.  Traveling abroad and under-developed countries, health care is not readily available like it is here.  So, if they do become ill, they may have to wait weeks to see a clinician or they may never see one.  This way, I am arming them and giving them skills and giving them the antibiotic and the information on when to use it so that they have a pleasant trip.  Many cases of traveler’s diarrhea are self-limited.  Three to five days without any intervention, they get better, but a client who is on a 10-day safari, they do not have the luxury of time, so I just tell them to take it.  It is best that they be comfortable that they get rid of this diarrhea so that they can enjoy their trip.  Traveler’s diarrhea is responsible for about 60% of post-travel complaints.  So, that is the biggest culprit in return travelers.  So, it is one that I spent a lot of time discussing with my client so that they do not get sick, so that they do enjoy their vacation.

Teera Wilkins           Thank you.

Teera Wilkins:          Thanks for listening.  Please feel free to leave us any comments on this Wellcast on the form at the bottom of this page.  If you have any story suggestions, please email us at or you can use the “Contact Us” page on our website at

— end of recording  —

Posted on Friday, May 23, 2014 in Occupational Health Clinic, Wellcasts and tagged , ,


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