Traveler's Diarrhea Prevention

FOOD AND WATER PRECAUTIONS

“BOIL IT, COOK IT, PEEL IT, OR FORGET IT”

Meticulous attention to food and water hygiene is beneficial but hard to accomplish in practice:

1. Drink canned or bottled carbonated beverages (from reliable sources), tea or coffee made with boiled water.

• The most effective way of purifying contaminated water is boiling for one minute (longer at high altitude). Filtration or chemical disinfection with iodine or chlorine is somewhat less effective but may be the only practical option.
• Very hot tap water ( > 50-60 C ) is relatively safe and can be used as a source of drinking water as a last resort.

2. Avoid milk (unless boiled or pasteurized) and milk products such as most cheeses, yogurt and ice-cream. Milk that has been irradiated (or x-rayed) or labeled “UHT” (for Ultra High Temperature”) is also safe.

3. Avoid ice unless made from boiled or purified water.

4. Use boiled or purified water for brushing teeth.

5. Meat or fish dishes should be well cooked, and eaten while still hot. Do not eat raw or undercooked meats.

6. Peel all fruit including tomatoes (inspect to ensure that the skins have not been punctured, wash with purified water, then peel!)

7. Avoid salads and raw vegetables.

8. Avoid cold platters, custards, pastries, etc.

9. Avoid shellfish unless very well cooked.

10. Avoid street vendors and fly infested restaurants.

PRACTICAL (SELF) MANAGEMENT OF DIARRHEA

FLUID AND ELECTROLYTE REPLACEMENT

• a. Drink purified water, weak tea, sodas, fruit juices, coconut milk, clear soups.
• b. Oral rehydration salts.
• (i) easily purchased in small packets from pharmacies overseas. Cost 5 - 10 cents per packet!
• (ii) Home made formula: Bring along a measuring spoon!

1 liter of clean water +

1/2 tsp baking soda

1/2 tsp salt

8 tsp sugar or 6 tsp Karo

1/4 tsp salt substitute

• c. Starch based rehydration solutions - Reduce stool volume and shorten the duration of illness.

(i) Store bought

Ricelyte (Mead Johnson)

Rice-based oral electrolyte maintenance solution

Cera-Lyte

(ii) Home made formula

1 liter water

20 gms (approximately 1/2 pound)mashed potato (8 oz)

50-60 gms (approximately 2 oz) of rice or cereal flour. Cook the potato, rice or cereal flour in the water and allow to cool then add:

1/2 tsp salt (provides sodium and chloride)

1/4 tsp baking soda (provides bicarbonate)

1/4 tsp salt substitute (provides potassium and chloride)

• d. Avoid alcohol, caffeine, milk and milk products.

Foods

Eat salted crackers, plain toast, rice, baked or mashed potatoes in the early stages. As symptoms improve, introduce foods such as bananas, baked chicken, or baked fish.

SMM 02, LYC