With international travel back on the upswing, I’ve been getting more calls recently for travel-related information. Fortunately, the precautions and medications needed for most travelers are straightforward. I will cover general preparations for travel, tips to keep in mind while traveling, and finally, I will touch upon a common cause of pre-travel anxiety: traveler’s diarrhea (aka “Montezuma’s Revenge”).

Before You Go:

The Internet is an invaluable source of information for travelers. Before going abroad, a “must-see” site is the Center for Disease Control’s traveler’s health site, www.cdc.gov/travel. Here one can find out which vaccines are required or recommended for travel in specific regions, obtain detailed information on specific diseases or outbreaks which may be encountered, access tips on finding safe food and water, and even find inspection scores for specific cruise ships. The state department lists English-speaking doctors, hospitals, medical and dental clinics for specific areas at travel.state.gov/acs.html. Travel clinics at state and local health departments can be located at www.cdc.gov/mmws/international/relres.html.

Plan to see your physician at least six weeks before you leave if you will need immunizations. This would also be a good time to check up on any ongoing health problems and to ask about any medications you might want to take along, such as anti-malarials, if indicated, or an antibiotic to take if you get diarrhea. Pack your medications in their original containers, and consider taking an extra prescription for them, as well as eyewear prescriptions.

A first-aid kit is also a good idea. This may include Pepto-Bismol, Imodium, antacids, cough/cold/allergy medications, pain medication (acetaminophen, ibuprofen, or aspirin), antibiotic ointment, lip balm, sunscreen with SPF of at least 15, and Dramamine for motion sickness. Bandages, moleskin, scissors, nail clippers, a pocketknife, and a thermometer may also come in handy.

While You Are Traveling:

Eat and drink carefully if you are going to an area with a higher risk for traveler’s diarrhea. Steaming-hot, well-cooked food, and hot or carbonated beverages or bottled water are safest. Avoid raw or undercooked meat or seafood, un-pasteurized dairy products, and anything from street vendors. Peel fruits yourself. Avoid ice, lettuce, and cut-up fruit salad. Brush your teeth with bottled water.

If traveling to a country with mosquito-borne disease risk, use Deet-containing insect repellant, use bed nets while sleeping, and take anti-malaria medication if indicated. Jet lag can be minimized before a long trip by going to bed one hour earlier or later for each time zone crossed. Try to schedule a day of rest after passing six or more time zones. Over-the-counter melatonin (1-5 mg) can be taken for three to four nights at destination bedtime before or after arrival.

Traveler’s Diarrhea:

The question I’m asked most frequently by would-be travelers is “Should I take an antibiotic daily to prevent diarrhea?” The answer is, for the most part, no. The exceptions to this rule are those with chronic diseases such as significant heart or kidney disease, diabetes, cancer, AIDS, etc., or perhaps those traveling to very high-risk areas, such as refugee camps, for less than a three-week stay. Ask your doctor if you are unsure.

The best way to avoid traveler’s diarrhea is to strictly adhere to the dietary recommendations listed previously. Pepto-Bismol may also be used for prevention. The dose is two tablets three to five times daily (with meals and with any other questionable food or drink). Be aware that this medication may turn the tongue and stools black.

If you are unlucky enough to get traveler’s diarrhea, remember that it almost always resolves on its own. It is important to replace the fluids lost by drinking plenty of liquids. An oral rehydrating solution is best, but if this is not available, drink pasteurized fruit juices, caffeine-free soft drinks, or bottled water, along with eating salted soda crackers. For moderate diarrhea (three or more stools in eight hours or less), Imodium or Pepto-Bismol may be helpful. Your doctor may also recommend taking a short course of an antibiotic if you develop diarrhea. For diarrhea that is very severe or associated with lightheadedness, severe abdominal pain, blood in the stool, or fever of higher than 101 F, a physician should be consulted.

Hopefully this has been helpful, and happy traveling!