Antibiotic Approved For Traveler’s Diarrhea
FDA OKs New Type of Antibiotic to Prevent Montezuma’s Revenge
May 26, 2004 — The FDA has approved a new type of antibiotic that may not only prevent Montezuma’s revenge from spoiling your vacation, but it may also help prevent the spread of antibiotic resistance.
Today the FDA approved Xifaxan, the first oral antibiotic for the treatment of traveler’s diarrhea caused by infection with E. coli in people aged 12 and older.
The difference between Xifaxan and other oral antibiotics used to treat traveler’s diarrhea is that it stays in the gut and is not absorbed into the blood stream.
Researchers say using a gut-selective antibiotic like Xifaxan to treat traveler’s diarrhea rather than more powerful, antibiotics which get absorbed into the blood may help prevent the growth of bacteria that are resistant to antibiotics. This is an emerging problem that is making an increasing number of antibiotics ineffective against common bacterial infections.
Researchers say traveler’s diarrhea, also known as Montezuma’s revenge, affects up to 60% of international travelers and is particularly common among foreign visitors to Mexico, Latin America, Africa, and South Asia. The illness often causes short-term diarrhea and stomach pain but can also lead to long-lasting diarrhea or irritable bowel syndrome.
How Can I Protect Myself From Traveler’s Diarrhea
In areas with poor sanitation, only the following beverages may be safe to drink: boiled water, hot beverages made with boiled water, canned or bottled carbonated beverages, beer, and wine. Avoid ice, as it may have been made from contaminated water.
It is safer to drink from an unopened can or bottle than from a container that is not known to be clean and dry. Water on the surface of a beverage can or bottle may also be contaminated. Therefore, the area of a can or bottle that will touch the mouth should be wiped clean and dried. Where water may be contaminated, you should not brush your teeth with tap water.
What Causes Travelers’ Diarrhea
Travelers’ diarrhea usually is contracted by the ingestion of contaminated food or water. Contrary to common belief, food – not water – is the primary cause. The CDC estimates up to 80% of cases of travelers’ diarrhea are caused by bacteria. The most common bacterium that causes travelers’ diarrhea is enterotoxigenic E. coli, one of six classes of enterovirulent E. coli.
Most E. coli are harmless. However, there are six unique classes of E. coli that can cause inflammation of the stomach and bowels and are termed enterovirulent. They are virulent to the intestine .
Collectively, these six classes of enterovirulent E. coli are referred to as the EEC group . Each class of EEC is distinct and different from the others.
- Enteroinvasive E. coli invades the intestinal wall to produce severe diarrhea.
- Enterohemorrhagic E. coli is a type of EHEC, E.coli0157:H7 that can cause bloody diarrhea and hemolytic uremic syndrome .
- Enterotoxigenic E. coli is the one that causes most travelers’ diarrhea and produces a toxin that acts on the intestinal lining.
- Enteropathogenic E. coli can cause diarrhea outbreaks in newborn nurseries.
- Enteroinvasive E. coli invade the epithelial cells causing diarrhea with mucus and blood.
- Enteroaggregative E. coli can cause acute and chronic diarrhea in children.
- gurgling .
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Is Travelers Diarrhea Contagious
Travelers diarrhea is often a symptom of an infection like e. coli or food poisoning. While by itself, it is not contagious, the infection that caused it may be. E. coli and many other diseases that cause travelers diarrhea spread through fecal matter, making it easier for those around someone with diarrhea to become infected.
If you, or someone with you, has travelers diarrhea, be sure to take extra precautions like washing hands reguarly and consider bringing a travelers diarrhea kit to help stop symptoms as quickly as possible.
Montezumas Revenge: A New Treatment Option
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One of the most disappointing situations you can encounter while traveling is the dreaded travelers diarrhea. Travelers diarrhea is the most common travel-related illness that can disrupt vacations and business plans when visiting low-income countries. The rate of travelers diarrhea has been reported to be as high as 70%, depending on the time of year and destination, but most recent data suggest that rates have decreased overall and are in the range of 10% to 40%. The highest risk for infection is within the first few weeks while abroad, and it somewhat decreases thereafter. The definition of classic travelers diarrhea is three or more diarrheal stools per day, along with at least one other clinical sign, such as abdominal cramps, fever, nausea or vomiting. Approximately 10% of those suffering from this illness will require medical care, and up to 3% may require hospitalization. On average, the duration of illness in those that go untreated is approximately 4 to 5 days.
Rifamycin SV-MMX pharmacology
The current approved dosage of RIF-MMX for treatment of travelers diarrhea is 388 mg twice daily for 3 days, which can be taken with or without food. Because the tablets are enteric coated, they should be taken whole and not split, crushed or chewed.
Clinical evidence supporting RIF-MMX
Safety
RIF-MMXs place in therapy
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- Passing three or more loose stolls in 24 hours
- An urgent need to defecate
- Abdominal cramps
- Fever and/or vomiting
Bacterial diarrhea lasts three to seven days. Viral diarrhea lasts two to three days. Protozoal diarrhea can last months without treatment.
Travelers diarrhea kits can help you overcome symptoms quickly. Call or book online now to get yours from a local Passport Health.
What Facts Should I Know About Traveler’s Diarrhea
What is the medical definition of traveler‘s diarrhea?
Diarrhea occurs in a significant number of people who travel to foreign countries. Travelers to developing countries of the world become ill from eating or drinking food or water contaminated by infected human bowel waste.
Traveler’s diarrhea can be defined as three or more unformed stools in a 24-hour period.
Who is at risk for traveler’s diarrhea?
- People traveling from industrialized countries to developing countries.
- Traveler’s diarrhea is more common in young adults.
- A large percentage of travelers to the high-risk areas will develop diarrhea.
High-risk areas
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What Are The Symptoms Of Travelers Diarrhea
Most people who get travelers diarrhea experience mild symptoms that improve within three to five days. Symptoms typically can appear within six to 24 hours after a bacterial or viral infection depending on the infection load. It may take one to three weeks for signs of an intestinal parasite infection to show up.
You may have travelers diarrhea if you experience three or more loose stools within 24 hours or your number of usual bowel movements doubles. You may also have one or more of these symptoms:
How Is Travelers Diarrhea Managed Or Treated In Adults
Treatments for travelers diarrhea include:
- Fluid and salt replacement: Oral rehydration salt solutions prevent dehydration by replenishing lost fluids and restore key electrolytes. Most stores and pharmacies in developing countries carry ORS packets approved by the World Health Organization . You can also drink bottled or boiled water and electrolyte beverages.
- Antidiarrheal medications: Medications, such as loperamide and atropine/diphenoxylate , can reduce the diarrhea symptoms but does not treat the infection and thus should only be taken with caution. Children under 12 and anyone who is immune compromised shouldnt take these drugs without consulting their healthcare provider.
- Antibiotics: If you have severe diarrhea , your healthcare provider may prescribe antibiotics. These medications include azithromycin , ciprofloxacin , doxycycline and rifaximin .
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How Modern Life Depletes Our Gut Microbes
So why don’t the locals get sick? They did when they were kids.
Young children in developing countries are frequently exposed to diarrhea-causing E. coli and thus build up immunity to these strains during the first few years of life. These types of E. coli are much rarer in the U.S., so kids here never become immune to them.
3. Washing my hands will keep me from getting sick. FALSE.
Sure, a quick wash with antibacterial soap will knock out bad E. coli. But that’s unlikely to cut your risk of getting sick, Shlim says.
“You can never really be against hand-washing,” he says. “But the fact is that it usually takes a high quantity of bacteria, sometimes in the millions, to overcome your stomach acid. So just the random bacteria you get on your hands, I think, is unlikely to make you sick.”
3. If I avoid certain types of foods, I won’t get sick. MAYBE.
The major source of traveler’s diarrhea is contaminated food and water at restaurants, Shlim says. Avoiding the bad water is easy just buy bottled water, boil it or treat ityourself. But thefood part is trickier.
Many travelers swear by the old saying “boil it, cook it, peel it or forget it.”
But scientific studies don’t really back it up. One meta-analysis of seven studies didn’t find a connection between getting bacterial diarrhea and eating raw vegetables or unpeeled fruits. But it did find a link between illness and foods that sat around at room temperature for a while.
5. If I get sick, I should take an antibiotic. MAYBE.
How Is Travelers Diarrhea Managed Or Treated In Children
Children are at particular risk for dehydration and serious problems caused by travelers diarrhea. You should check with your healthcare provider before giving a child any antidiarrheal medication. Certain drugs arent safe for children.
Treatment for children focuses on keeping them hydrated. Infants who are breastfeeding should continue to nurse. Formula-fed babies may benefit from formulas that have little, if any, lactose. This milk sugar can cause an upset stomach. Older children should be encouraged to eat and drink normally. Drinks with electrolytes or ORS can also help.
Contact your provider if your child has diarrhea and these symptoms:
- Bloody diarrhea.
- Fever higher than 102° F .
- Persistent vomiting.
- Signs of dehydration .
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How Is Travelers’ Diarrhea Diagnosed
The presumptive diagnosis of travelers’ diarrhea is based solely on the development of diarrhea when visiting a part of the world where this condition is common among travelers. Diarrhea usually is mild, self-limited, and resolves spontaneously. Symptoms usually can be controlled with over-the-counter medications Only when the diarrhea is severe or complicated, and possibly when antibiotics are contemplated, should attempts be made to identify the exact organism responsible for diarrhea so that the correct drug therapy can be selected. Identification may be difficult or impossible in undeveloped countries because of the lack of medical laboratories. When laboratories are available, the stool can be examined for parasites and cultured for bacteria. Identification of the pathogen results in a definitive diagnosis.
What Is Montezumas Revenge
Montezumas revenge is one of the most common travel illnesses, in which the digestion gets properly messed up. The diarrhea, which catches one in three long-distance travelers, is usually caused by the pathogens Escherichia coli or Campylobacter. The rule: Cook it, boil it, peel it or forget it helps to protect against the unpleasant diarrhea. If you get it anyway, you should fall back on your first-aid kit and be sure to drink plenty of fluids to counteract the loss of fluids. In the case of prolonged diarrhea, a bacterial and viral infection should be considered and a doctor should be consulted.
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How Does Travelers Diarrhea Spread
Travelers diarrhea is caused by eating or drinking contaminated food or water. Most often, the infection is from e. coli, but other diseases like cholera, typhoid or norovirus can cause the symptom. Bacterial infections are responsible for up to 80 percent of travelers diarrhea cases.
Most often, these infections spread through a food worker not washing their hands before preparing a meal. Improper sanitation within a kitchen or other similar area can also lead to infection. Fruit, vegetables and other items should be washed with clean water before eating to avoid contamination.
How Do I Treat Traveler’s Diarrhea
As with all diseases, it is best to consult a doctor rather than attempting to self-medicate for traveler’s diarrhea. This is especially relevant for pregnant women and children.
Pepto-Bismol decreases the diarrhea and shortens the duration of the illness. This medication also appears to be effective in preventing traveler’s diarrhea, but it should not be taken for more than three weeks at a time.
Side effects of Pepto-Bismol can include temporary blackening of tongue and stools, occasional nausea, constipation, and rarely, ringing in the ears. Do not take Pepto-Bismol if you have an aspirin allergy, renal insufficiency, gout, or if you are taking anticoagulants, probenecid , or methotrexate .
The most important treatment requires the replacement of fluids and salts lost from diarrhea. This is best achieved by use of an oral rehydration solution such as the World Health Organization oral rehydration salts solution. ORS packets are available at stores or pharmacies in almost all developing countries.
ORS is prepared by adding one packet to boiled or treated water. Packet instructions should be followed carefully to ensure that the salts are added to the correct volume of water. ORS solution should be consumed or discarded within 12 hours if stored at room temperature or within 24 hours if refrigerated.
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Q& a: Avoiding Montezumas Revenge
Whats the best way to prevent or treat travelers diarrhea? P.S., Oberlin, Ohio
For prevention, avoid contaminated food and water. Dont drink or brush your teeth with water that hasnt been boiled or purified, and avoid ice cubes. In many rural areas, only canned liquids and those that are bottled and carbonated are safe. Also avoid raw vegetables, cold cuts, dairy ingredients, and raw fruit that you havent peeled yourself. Dont buy food from street vendors, and eat meat and seafood only if theyre well-done and served hot.
If you anticipate poor sanitation, bring medication. Daily over-the-counter bismuth subsalicylate can cut your risk of developing diarrhea, and OTC loperamide can ease a mild case. Ask your doctor for a diarrhea-fighting prescription antibiotic, such as sulfamethoxazole and trimethoprim or ciprofloxacin , to treat severe cases accompanied by fever.
What Is Travelers’ Diarrhea
Travelers’ diarrhea is defined by most experts as three or more unformed stools in a 24 hour time period, passed by a person who is traveling. Travelers’ diarrhea is commonly accompanied by abdominal cramps, nausea, and bloating. Travelers’ diarrhea is a general term and does not specify any cause. Travelers’ from temperate regions of the world frequently experience diarrhea four days to two weeks after arriving in certain other areas of the world. Other terms used to describe this illness include “Montezuma’s Revenge,” the “Aztec Two Step,” and “Turista” in Mexico, the “Delhi Belly” in India, and the “Hong Kong Dog” in the Far East.
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How Can Travelers Diarrhea Be Treated
In diarrheal diseases, the body loses a lot of fluid. To rebalance the waterbalance as well as the electrolyte balance, the body should be given plenty of tea, diluted juices, vegetable broth or soups. Fatty foods, on the other hand, should be avoided during the period of illness. Light foods such as rusks, salty cookies or grated apples, on the other hand, are a good choice. In addition, taking healing clay also soothes the intestines, as harmful bacteria are bound and eliminated. The home remedy cola with salt sticks, however, is not suitable as a remedy for travelers diarrhea. The caffeine in the cola stimulates the intestinal activity further and can thus lead to a worsening of the symptoms. In addition, the sugar it contains causes further fluid loss in the intestines.
How Do You Prevent Traveler’s Diarrhea
Avoid these foods when traveling:
- Raw vegetables
- Any food from street vendors
These foods and drinks are generally safe to eat and drink.
- Well-cooked fish, meats, and vegetables served hot
- Carbonated beverages
- Boiled water
- If boiling water is not possible, other options include putting tincture of iodine drops in water , use of tetracycline iodine drops in water, or chlorine bleach to treat water . These preparations can be obtained from camping and sporting goods stores. These methods are not as effective if water is cloudy or muddy.
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How Can Travelers’ Diarrhea Be Prevented
Since food is the major source of infection, close attention to diet is of foremost importance in the prevention of travelers’ diarrhea.
- Foods should be well-cooked and served warm.
- Raw vegetables, uncooked meat or seafood, and other foods maintained at room temperature should be avoided.
- Dairy products, tap water, and ice are also high-risk foods.
- Carbonated beverages, beer and wine, hot coffee and tea, fruits that can be peeled, and canned products generally are safe.
- The risk for developing diarrhea increases when eating at restaurants and when purchasing food from street vendors.
- Also, frequent hand washing with soap and clean water will decrease the likelihood of the bacteria’s spread, especially to other people that the person may be traveling with.
Antibiotics can be effective in preventing travelers’ diarrhea but are not recommended for most people due to possible side effects .
Bismuth subsalicylate also can be effective in preventing diarrhea in travelers although Pepto-Bismol may cause black stools and, rarely, ringing in the ears. People allergic to aspirin should avoid Pepto-Bismol. Studies have not shown bismuth subsalicylate to be safe for use longer than three weeks.
Probiotics such as Lactobacillushave shown inconclusive results in the prevention of travelers’ diarrhea.
