Each year, up to 40 percent of travelers worldwide are hit by a painful disorder in the digestive tract called traveler’s diarrhea.
The condition, which is defined by having three or more unformed stools in 24 hours, can derail your travel plans and leave you bedridden with nausea, abdominal cramps, and persistent vomiting.
Now, adult travelers have a new treatment option for when diarrhea strikes.
The FDA recently approved an antibacterial drug called Aemcolo (rifamycin) to relieve the uncomfortable symptoms caused by noninvasive Escherichia coli (E. coli) that do not involve bloody stools or fever.
The drug, which is to be taken orally, is expected to be available by February, the FDA stated.
In order to test the efficacy of Aemcolo, researchers studied 264 adults with traveler’s diarrhea in Guatemala and Mexico. The clinical trial found that Aemcolo significantly alleviated symptoms of diarrhea in patients compared to a placebo.
The safety of the drug was then evaluated in 619 adults with traveler’s diarrhea in two controlled clinical trials. According to the FDA, the most common adverse side effects were headache and constipation.
Aemcolo was not effective in those who experienced fever and/or bloody stools caused by pathogens other than E. coli.
Traveler’s diarrhea typically sets in after consuming food or water that’s contaminated with invasive and noninvasive bacteria, viruses, and parasites.
Bacterial pathogens are the most common culprit, according to the Centers for Disease Control and Prevention (CDC).
E. coli causes the majority of attacks. The noninvasive bacteria attach to the lining of your intestine and release a toxin that triggers diarrhea and cramps.
More invasive bacteria — like Campylobacter jejuni, Shigella spp., and Salmonella spp. — cause bloody diarrhea along with a high fever.
Traveler’s diarrhea can strike anywhere, the CDC states, but is most common in Asia, the Middle East, Africa, Mexico, and Central and South America. Eastern Europe, South Africa, and certain islands in the Caribbean are considered to be higher-risk areas as well.
In most cases, traveler’s diarrhea doesn’t cause serious complications, notes the Mayo Clinic, and usually goes away on its own within a few days.
In more extreme cases that involve severe dehydration, persistent vomiting, a high fever, or bloody stools, it’s crucial to seek medical treatment immediately. Severe dehydration can be fatal, as you may lose a significant amount of vital fluids, salts, and minerals.
The two types of medications used to treat traveler’s diarrhea fall into two categories: symptomatic relief (think anti-diarrheals) and antibiotics — like azithromycin, ciprofloxacin, rifaximin, and now rifamycin — which can help clear out the bacteria and speed up recovery.
Azithromycin is often recommended as one of the first-line antibiotic treatments for more severe traveler’s diarrhea, as it covers a broader amount of pathogens.
“Rifamycin is different from other antibiotics such as ciprofloxacin and azithromycin because it is [minimally] absorbed and is thus delivered directly to the site of infection,” Dr. Amesh Adalja, an infectious disease specialist and senior scholar at the Johns Hopkins Center for Health Security, explained. “[Therefore] it is less likely to impact bacteria in other locations and less likely to have systemic side effects.”
Because certain bacteria have become increasingly resistant to antibiotics, some health experts believe that the discovery and approval of new treatments, such as rifamycin, are extremely valuable.
Others argue that traveler’s diarrhea caused by E. coli may not even require antibiotics — and that the treatment may ultimately do more harm than good if overprescribed or misused.
“[Aemcolo] is only approved for the treatment of noninvasive E. coli, which is a self-limited infection that some would argue doesn’t even require antibiotic treatment, but rehydration and/or loperamide as a mainstay of therapy,” Dr. Theresa Fiorito, a pediatric infectious disease specialist at the Family Travel Clinic with NYU Winthrop Hospital, said.
“There is increasing concern within the travel community about the misuse of empiric antibiotics and ‘overtreatment’ of diarrhea encountered while abroad. For this reason, only in cases of moderate or severe diarrhea should antibiotics be considered or recommended, respectively,” Fiorito added.
Regardless, the most important thing to do if you catch traveler’s diarrhea is to focus on rehydration, Fiorito explained. This — in addition to over-the-counter medications like loperamide — is considered to be your first line of defense.
Fortunately, you can significantly reduce your chances of traveler’s diarrhea by steering clear of the pathogens that trigger it.
When in doubt, boil it, cook it, peel it, or forget it, as the saying goes. High heat kills germs, so make a point to eat food that’s cooked and hot, rather than served at room temperature.
“Avoiding high-risk foods that are handled by individuals but not cooked, like vegetables, can be helpful,” Adalja advised. He also recommends avoiding tap water and opting for bottled water instead.
Adalja suggests taking a bismuth-containing medication — such as Pepto-Bismol — which can act as a preventive. Doing so can decrease incidences of traveler’s diarrhea by nearly 50 percent, the CDC reports.
Each case varies: Where one person may only require rehydration therapy, another may benefit from a full course of antibiotics. A healthcare provider can determine the best course of action for your specific symptoms.
While traveler’s diarrhea is typically harmless, treating it quickly could be the difference between productive, healthy travel and a trip spent curled up in bed.