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Q: When this pandemic quarantine lifts, I am planning to travel outside the country. I heard from a friend about his bad experience with “travelers’ diarrhea.” What can I do to prevent that and fully enjoy my trip?

A: While travelers’ diarrhea is one of the most predictable illnesses for travelers, the old rule that you should “boil it, cook it, peel it or forget it” has still allowed people to become sick. 

In addition, while underdeveloped places with warmer climates and denser populations tend to carry a higher risk for travelers’ diarrhea — usually due to a lack of clean water and adequate plumbing systems, as well as different handwashing habits — travelers to developed places also can develop diarrhea from inadequate handling and preparation of food in restaurants.

Therefore, if you are traveling abroad, especially to a high-risk place, you can reduce — though not eliminate — your risk for travelers’ diarrhea by making sure you do the following:

• Wash your hands with soap where available.
• Carry small containers of alcohol-based hand sanitizers.
• Only eat hot foods — avoid salads, uncooked vegetables, raw and unpeeled fruits, and fresh and unpasteurized fruit juices.
• Look for steam coming off your food, especially at restaurants.
• Drink only unopened, commercially bottled beverages.
• Avoid drinking or using any tap water, unless it has just been boiled.
• Avoid drinks with ice.

Over-the-counter meds may help

In addition, Pepto-Bismol and Kaopectate, both of which contain bismuth subsalicylate, can be taken as either 2 ounces of liquid four times per day or two chewable tablets four times per day to prevent travelers’ diarrhea. Common side effects of these medications include a darkening of the tongue and stool, nausea and constipation. Rarely, these medications can cause ringing in the ears (also called “tinnitus”). 

These medications should be avoided if you have an aspirin allergy, kidney problems or gout, or if you are taking blood thinners or the drugs probenecid or methotrexate. Also, these medications should be avoided by pregnant women and by children under 12.

Antibiotics are generally not recommended to prevent travelers’ diarrhea. Along with their side effects, when antibiotics are used to avoid diarrhea, they can actually spread resistance to these drugs, which can make treating diarrhea and other infections more difficult. 

However, there are instances where antibiotics are appropriate, especially if you have a weak immune system or if you have significant medical conditions. Speak to your doctor or pharmacist if you have concerns or if you have any questions about these or other medications.

If you do become sick with travelers’ diarrhea, you might experience mild or severe cramps; urgent, loose stools; fever; vomiting or bloody diarrhea.

If you develop these symptoms, speak to a doctor and be sure that you stay hydrated, especially with bottled sports drinks to replenish your electrolytes. 

In addition, while there are no vaccines for most cases of travelers’ diarrhea, speak to your doctor at least two months before your trip about vaccines you should get to help prevent other diseases that are common where you are traveling.

Christian Ruiz recently graduated with a Pharm.D. from VCU School of Pharmacy and is currently pursuing a PGY-1 Pharmacy Residency at CJW Medical Center in Richmond. His current career interests include emergency medicine, critical care and internal medicine.