Both food and water can be the source of infection. Travelers who avoid drinking local water may still become infected by brushing their teeth with an improperly rinsed toothbrush, drinking bottled drinks with ice made from local water, or eating food that is improperly handled or washed with local water. Most cases are mild and self-limited, although dehydration can occur, especially in warm climates. People taking drugs that decrease stomach acid (antacids, H Nausea, vomiting, hyperactive bowel sounds, abdominal cramps, and diarrhea begin 12 to 72 h after ingesting contaminated food or water. dosing is 4 mg po initially, followed by 2 mg po for each subsequent episode of diarrhea (maximum of 6 doses/day or 16 mg/day). An alternative for adults is diphenoxylate 2.5 to 5 mg po tid or qid in tablet or liquid form. The dose of for children 13 to 21 kg is 1 mg after the first loose stool then 1 mg after each subsequent loose stool (maximum dose is 3 mg/day); for children 21 to 28 kg, 2 mg after the first loose stool then 1 mg after each subsequent loose stool (maximum dose is 4 mg/day); and for children 27 to 43 kg, up to age 12, 2 mg after the first loose stool followed by 1 mg after each subsequent loose stool (maximum dose is 6 mg/day). Antimotility drugs are contraindicated in patients with fever or bloody stools and in children Travelers should dine at restaurants with a reputation for safety and avoid foods and beverages from street vendors. They should consume only cooked foods that are still steaming hot, fruit that can be peeled, and carbonated beverages without ice served in sealed bottles (bottles of noncarbonated beverages can contain tap water added by unscrupulous vendors); uncooked vegetables (particularly including salsa left out on the table) should be avoided. Traveler’s diarrhea (dysentery, Montezuma’s revenge) is usually a self-limiting episode of diarrhea that results from eating food or water that is contaminated with bacteria or viruses. Traveler’s diarrhea is most common in developing countries that lack resources to ensure proper waste disposal and water treatment. Onset is often sudden and usually lasts 3-5 days or longer. The severity of diarrhea can vary and can be accompanied by cramps, bloating, nausea, vomiting and /or fever. In severe cases, life-threatening dehydration can occur, especially in babies, young children and the elderly. It is estimated that up to 40% of travelers experience some form of traveler’s diarrhea. The best practice is to avoid eating and drinking food and water that are contaminated with human waste (stool, feces). This can be accomplished by: How do I treat traveler’s diarrhea?
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