Traveler's Insurance

You're in Denver on business or hiking the Andes of Peru when, boom, it hits you. You've got—ahem, ahem—traveler's diarrhea (TD).

You're not alone. TD is the most predictable of travel ailments, affecting 30% to 70% of travelers annually.

"Everyone is at risk of a foodborne illness, even in the developed world," says Phyllis Kozarsky, a physician at the Emory TravelWell Center and a CDC consultant. "For lack of a better term, traveler's diarrhea is the bread and butter of travel medicine."

Physicians at TravelWell routinely provide pre-travel advice, including how to prevent and treat diarrhea. The tips sound familiar: Wash your hands often. Order cooked foods served steaming hot. Eat fruits and vegetables you can peel. Skip buffet foods that may have sat out for too long. Drink bottled and canned beverages. Pack Imodium or Pepto-Bismol in your suitcase to take at the first sign of TD. If you become ill, drink bottled water or soda to stay hydrated.

TravelWell doctors also prescribe an antibiotic to take along for treating TD. But the rule on when to take it recently changed. Until last year, physicians instructed travelers to take an antibiotic for TD that is mild (tolerable), moderate (distressing or interferes with planned activities), or severe (incapacitating). Now they advise travelers to take an antibiotic only for moderate or severe TD and use Pepto-Bismol or Imodium for mild TD.

The change is included in new TD prevention, management, and treatment guidelines set by the International Society of Travel Medicine, which met at Emory last year. The revision was made to address concerns about antibiotic resistance to bacteria that cause TD. "Antibiotic resistance shows up everywhere in the management of infectious diseases," says Kozarsky. "We now know it's best not to take an antibiotic immediately for traveler's diarrhea, but we still advise people to take an antibiotic with them when they're traveling outside the country.

What's in your travel kit?

When traveling, TravelWell's Phyllis Kozarsky takes a kit filled with ibuprofen, acetaminophen, decongestant, anti-itch cream, bandages, and tweezers. She also carries Imodium, Pepto-Bismol, and an antibiotic.

"I'm susceptible to traveler's diarrhea," she says. "It helps to be prepared, especially in developing countries where medicines may be counterfeit or have ingredients that are less active or contaminated."