The traveler’s diarrhea is diarrhea which is seen among traveler’s (mainly from developed country to a developing country, but can occur during travel from anywhere to other country and in on study the rate of traveler’s diarrhea was, as low as 8% per 2-week stay in industrialized countries and as high as 55% in parts of Africa, Central and South America, and Southeast Asia), that is generally short lived and self limited. Though short lived about 40% of affected individuals need to alter their scheduled activities and another 20% become bedridden for few days. The causative organisms of traveler’s diarrhea are entero-toxigenic Escherichia coli and entero-aggregative E. coli. Sometimes it may be due to Campylobacter infections, Salmonella, Shigella or rotavirus.
Traveler’s diarrhea can occur despite rigorous precautions regarding food and water during travel to a developing country, all the traveler’s should carry some medication for self-treatment with them (preferably traveler’s medical kit). Antibiotic therapy will generally reduce the duration and severity (reduce frequency of stools) of traveler’s diarrhea in moderate to severe cases. The standard antibiotic regimen for traveler’s diarrhea is 3-day course of quinolone like ciprofloxacin (single double dose of quinolone is equally effective regimen). But if you are traveling to Thailand quinolone like ciprofloxacin will not work due to resistance (in Thailand more then 90% of traveler’s diarrhea is due to Campylobacter infections which are resistant to quinolone like ciprofloxacin) and azithromycin is a better alternative in such cases. Rifaximin (a poorly absorbed rifampin derivative) is also highly effective (especially against noninvasive bacterial pathogens such as entero-toxigenic and entero-aggregative E. coli) alternative to quinolone.
The present recommendation of self-treatment of travelers’ diarrhea is for the traveler to carry three once-daily doses of an antibiotic (azithromycin or ciprofloxacin) and to use as many doses as necessary to correct the diarrhea. If there is no fever or blood in stool, loperamide can be taken in combination with the antibiotic (but never take loperamide if you have fever or blood in stool as it may prolong diarrhea).