By Dr. W. Gifford Jones
"Please, Dear Lord, above all other wordly goods grant me a bathroom." I doubt there are many travellers who haven't raised this silent prayer to the Almighty. Some fervently issue this entreaty on a bus when the next stop is still miles away. Others in a state of desperation, lift this plea to Heaven when a plane is delayed on the runway and the toilet's door is still locked. Traveller's Diarrhea can strike with the speed of lightning. Andwhen it does, the last problem on your mind is whether it's called Montezuma's Revenge, the Hong Kong Trots or the Casablanca Crud.This year thousands of Canadians will once again repeat this prayer to the Almighty. Other travellers who take prophylactic antibiotics will prevent the ubiquitous malady. Who should and who shouldn't take this medication?
Traveller's Diarrhea isn't due to a single organism. But it's most commonly caused by a problem strain of E. coli which is normally an inhabitant of the large bowel. The problem strain, however produces a toxin which decreases the ability of the bowel to absorb fluid. This triggers a watery diarrhea, varying degrees of abdominal cramps and a cold, perspiring brow while you desperately search for the nearest bathroom.
Dr. Dilip Patel, an Ottawa gastroenterologist, says that living like a Roman in Rome is a dangerous game to play. So don't be like the Mexicans and drink their water, or put ice in your scotch and soda. And always in southern climes say no to street vendors, fresh salads and shellfish. But staying away from contaminated food and water is easier said than done on a trip. That's why a continuing debate rages on the pros and cons of prophylactic antibiotics.
Some authorities contend such an approach is a potentially dangerous game. After all 50 per cent of travellers don't develop this malady. And on rare occasions antibiotics can cause serious damage to the large bowel. Like everything else in life the risk and the advantage of this preventative medicine must be weighed. There are times, nevertheless, when the advantage of antibiotic therapy outweighs the danger.
A businessman or politician may be going to China to make an important speech. It's a disaster after travelling several thousand miles and following weeks of preparation to be struck down by the "Ho Chi Minhs" a few hours before reaching the podium. Athletes who have been training for months or years may also decide that antibiotics are the lesser of two evils.
Dr. Jay Keystone, director of the Tropical Disease Unit at The Toronto General Hospital, advises most people to stay away from prophylactic antibiotics. But he admits there are exceptions to this general rule. For instance, you have to take a hard look at your past track record. If you start to get a queasy stomach as soon as you get off the plane in Zurich, or invariably spend several days of every vacation in the bathroom, it's best to reach for antibiotics. He also advises very important short-term travellers who can't afford to lose one day on a vital trip to take antibiotics.
Prophylactic antibiotics are also indicated when travellers suffer from medical conditions such as diabetes and inflammatory bowel disease. A bout of severe dehydration on a trip can cause serious complications.
Travellers should begin taking antibiotics the day of departure and continue them for two days after returning to Canada. A variety of antibiotics are available. Trimethoprim/sulfamethozazole (septra), one tablet twice a day, helps to prevent infection but in one to four per cent of travellers causes a skin rash and sore mouth. If the person is allergic to sulfa, trimethoprim can be prescribed alone.
Dr. Keystone says a 100 milligram capsule of doxycycline (vibramycin), a relatively long-acting tetracycline,taken daily will prevent diarrhea in 70 to 95 per cent of travellers. But the trip must not last longer than two weeks.
Doxycycline can itself cause diarrhea and should be consumed with or immediately following a meal to decrease the chance of nausea. Like other tetracyclines it can cause photosenstivity reactions and vaginal fungus infections. It should not be prescribed to pregnant women or children under eight years of age because it can stain developing teeth.
Norfloxacin has also helped many travellers. One hundred and twenty students attending summer school in Mexico were given 400 milligrams of norfloxacin daily. 7 per cent of those taking the antibiotic developed diarrhea compared to 67 per cent of those not on this medication.
Next week a report on a new unique container that fights Traveller's Diarrhea. And why no one should leave home without one.
W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com
My book, �90 + How I Got There� can be obtained by sending $19.95 to:
Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1
Pre-2008 articles by Gifford JonesPursuant to Title 17 U.S.C. 107, other copyrighted work is provided for educational purposes, research, critical comment, or debate without profit or payment. If you wish to use copyrighted material from this site for your own purposes beyond the 'fair use' exception, you must obtain permission from the copyright owner. Views are those of authors and not necessarily those of Canada Free Press. Content is Copyright 1997-2024 the individual authors. Site Copyright 1997-2024 Canada Free Press.Com Privacy Statement