What are the best methods to prevent traveler's diarrhea?

Prevention of Traveler's Diarrhea

The best methods to prevent traveler's diarrhea include practicing careful food and water precautions, avoiding high-risk foods and beverages, and using bismuth subsalicylate for short-term prophylaxis in selected cases, while routine antibiotic prophylaxis is not recommended for most travelers. 1

Food and Water Precautions

Safe Food Practices

• Avoid high-risk foods:
  • Raw fruits and vegetables (unless you can peel them yourself)
  • Raw or undercooked seafood or meat
  • Items sold by street vendors
  • Unpasteurized milk and dairy products 1
• Choose safer options:
  • Well-cooked food served hot
  • Fruits you can peel yourself 2

Safe Beverage Practices

• Safe beverages include:
  • Bottled beverages (commercially sealed)
  • Hot coffee and tea
  • Beer and wine
  • Water boiled for >1 minute 1
• Avoid:
  • Tap water in high-risk areas
  • Ice cubes made from untreated water
  • Swallowing water while swimming 1, 2
• Water treatment options:
  • Boiling (>1 minute)
  • Treatment with iodine or chlorine 1

Non-Antibiotic Prophylaxis

Bismuth Subsalicylate

• Can be used for short-term prophylaxis in selected cases
• Moderately effective but somewhat inconvenient 3, 2
• Approved for relief of traveler's diarrhea symptoms 3

Antibiotic Prophylaxis

General Recommendations

• Not recommended for routine use in healthy travelers 1
• Reasons to avoid routine antibiotic prophylaxis:
  • Promotes development of drug-resistant organisms
  • Risk of adverse effects
  • Limited duration of benefit 1

Special Considerations

• May be considered only for high-risk travelers:
  • Immunocompromised individuals
  • Those with underlying health conditions that would be severely impacted by diarrhea 1, 2

Practical Advice for Travelers

Hand Hygiene

• Wash hands frequently, especially:
  • Before eating
  • After using the bathroom
  • After touching public surfaces 1

Restaurant Selection

• Choose restaurants with good hygiene practices
• Avoid unhygienic-appearing establishments 2

Self-Treatment Preparation

• Travelers should carry:
  • Oral rehydration solutions
  • Loperamide (except for use with high fever or bloody diarrhea)
  • Appropriate antibiotics (azithromycin preferred) for self-treatment if moderate to severe diarrhea develops 1

When to Seek Medical Attention

• Severe diarrhea not responding to empiric therapy
• Blood in stool
• Fever with shaking chills
• Signs of dehydration 1

Special Populations

Immunocompromised Travelers

• Higher risk for foodborne and waterborne infections
• May need more aggressive prophylaxis strategies
• Should consult with healthcare provider before travel 1

Children and Pregnant Women

• Extra caution with food and water
• Different treatment recommendations if diarrhea occurs (azithromycin preferred over fluoroquinolones) 1

Emerging Preventive Strategies

• Vaccines against enterotoxigenic E. coli are under development but not yet available for routine use 4
• Nonabsorbed antimicrobial agents are being studied 4

Despite best preventive efforts, travelers' diarrhea remains common with attack rates of approximately 40% in high-risk areas 5, 6. Food and water precautions, while important, provide no guarantee of success in preventing traveler's diarrhea 2. Therefore, being prepared for self-treatment is an essential component of travel planning.