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Say No to Antibiotics for Traveler’s Diarrhea

Date: March 16, 2015      Publication: Daily Health News      Source:  Anu Kantele, MD, PhD, Helsinki University Central Hospital      Print:

When you have a serious infection, you want your antibiotic to work fast and thoroughly and to kill the bacteria before they possibly kill you. But if the bacteria causing infection have learned to outsmart the antibiotic, then you’re in real trouble. Overuse and inappropriate use of antibiotics are key factors in training bacteria to trump treatment.

So if you thought you could avoid a really uncomfortable case of diarrhea by popping an antibiotic—as many travelers do to avoid traveler’s diarrhea—would you?

I hope not. And I’ll tell you why.

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When you overuse antibiotics, you are not only setting yourself up for antibiotic resistance, you are also contributing to a looming threat that affects us all. The problem was most recently exemplified by an E. coli outbreak in Illinois caused by a drug-resistant South Asian strain of E. coli and a related deadly superbug outbreak in California. The strain could have originated in a traveler and was spread to others through medical equipment even though the equipment had been properly disinfected. Now, a large Finnish study warns that antibiotic use to prevent or treat traveler’s diarrhea may be the perfect storm for contracting superbugs during your travel, potentially leading to more scenarios like the one seen in Illinois.

AN UNWELCOME SOUVENIR

Not everything you bring home from a trip abroad fits in your suitcase. Like rats on an old seafaring ship, organisms can stow away in your body. A study involving 430 Finns who were traveling outside of Scandinavia showed how common a transfer of bacteria from one locale to another is. In this study, each participant completed a questionnaire before and after his or her trip. The questionnaires gathered information about each traveler’s personal and medical history, travel itinerary, any medical symptoms that developed during travel and any medications used. Special attention was given to incidence of traveler’s diarrhea and antibiotic use to treat it. Researchers also analyzed travelers’ stool samples before departure and upon return to track what kind of intestinal bacteria they were carrying. And travel destinations were divided into seven regions—South Asia (India, Pakistan and nearby locales), Southeast Asia, East Asia, North Africa and the Middle East, sub-Saharan Africa, South and Central America and the Caribbean, and Europe, Australia and North America.

The results: Among those who got traveler’s diarrhea, a stunning 46% who took antibiotics for it came home with antibiotic-resistant intestinal bacteria in their bodies (namely strains of E. coli)…compared with only 17% of those who didn’t take antibiotics.

The most likely place to pick up these “bugs” was South Asia, where 46% of visiting travelers were affected. Thirty-three percent of travelers visiting either Southeast Asia, East Asia or North Africa and the Middle East were affected, as were 12% of visitors to sub-Saharan Africa. Meanwhile, all travelers to Europe, Australia and the Americas returned home unscathed.

AVOID HITCHHIKING SUPERBUGS

Although antibiotics are extremely useful in quashing bacterial infections, they can disrupt the microbial ecosystem in our guts, where “good” bacteria keep the less friendly disease-causing bacteria in check. When antibiotic use upsets the balance, it becomes easier for pathogens to invade the gut, thrive and, among travelers, hitch rides back to a traveler’s native land where the bugs can spread to others. If they cause an infection, treatment becomes a challenge because these microbes can be resistant to commonly used antibiotics.

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Rather than taking an antibiotic to prevent or treat traveler’s diarrhea, the study researchers gave recommendations that mirror those of the US Centers for Disease Control and Prevention (CDC) and noted that travelers to Asia—particularly South Asia—and Africa should be extra vigilant.

Although the CDC affirms that taking an antibiotic is, in fact, effective in preventing traveler’s diarrhea, it recommends that travelers, instead, take bismuth subsalicylate (none other than Pepto Bismol) if they want to take prophylactic treatment. Bismuth subsalicylate provides some protection against harmful gut bacteria without promoting antibiotic resistance, according to the CDC. It recommends two tablets or two fluid ounces of bismuth subsalicylate four times per day but not for more than three weeks. But this prophylactic treatment is not for you if you are allergic to aspirin or on blood thinners, probenecid or methotrexate—and it should not be used by pregnant women.

Better than taking a drug to prevent traveler’s diarrhea, though, the CDC and Finnish researchers both urge you to simply be careful about food and hygiene while traveling to countries known to be hot spots for traveler’s diarrhea. Avoid…

  • Tap water unless it has been boiled. Use bottled water for drinking and teeth-brushing—and don’t let ice cubes land in your libations.
  • Food and beverages sold by street vendors and at locales that appear to be off-the-beaten-path or unsanitary.
  • Raw or undercooked meat and seafood as well as uncooked vegetables. In fact, make sure that all your meals are served well-cooked and warm.
  • All raw fruit unless the fruit has a thick peel (examples: bananas, oranges and avocados) that you can wash with bottled water before peeling.

If you get hit with traveler’s diarrhea…sure, it’s inconvenient, but it is usually a mild illness that resolves within a few days without treatment and is rarely life-threatening, said lead author of the study, Anu Kantele, MD, PhD, associate professor in infectious diseases at Helsinki University Central Hospital. She recommends loperamide (Imodium) for people with traveler’s diarrhea without fever who need symptom relief—for example, relief from symptoms in order to sit through a long plane flight home.

The recommendation given by the CDC is very basic and what we all know to do—drink lots of clear fluids to stay hydrated. However, the CDC and Dr. Kantele recommend that if symptoms are severe, especially if you are running a high fever or if your stools are bloody, then, taking an antibiotic may be a wise choice despite the risk of contracting antibiotic-resistant bacteria.

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Source: Anu Kantele, MD, PhD, associate professor in infectious diseases, Helsinki University Central Hospital, Finland. Her study was published in Clinical Infectious Diseases.