Travelers Diarrhea Treated with Probiotics

Lucky you! You're off to some far flung exotic land with your wallet strapped to your body and your fingers crossed that you don't go down with travelers' diarrhea.

Or traveller's diarrhea if you like it spelt that way - either way, you'll still be running just as fast for the nearest toilet!

It mostly strikes people from the industrialised countries who travel to tropical and semi-tropical parts of the world and happens when pathogens such as Escherichia coli gain a foothold in the intestinal tract of our unsuspecting traveler. Diarrhea strikes! A miserable few days follow.

As the pathogens are usually of bacterial origins, it means that antibacterials such as rifaximin are effective if you prefer a more conventional diarrhea cure than probiotics offer.

Who is most at risk of getting travelers diarrhea?

• Travelers from a low-risk area visiting a high-risk area. Most parts of Latin America, Africa and Southern Asia would be viewed as high-risk in this context.

• Young people

• Travelers with a lack of previous travel to a high-risk region in the prior six months

• Lack of care in food and drink choices

• A person's genetics can leave them vulnerable¹

Which probiotic will deal to travelers diarrhea?

Saccharomyces boulardii looks like the star runner. This is a yeast that was "discovered" on Indochinese lychee fruit when it was noted that the local people made a popular medicine from them for the treatment of diarrhea.² It is now widely available in European, African and South American countries.

It has performed well through several trials.³

It should not be taken by immunsuppressed people or if you’re allergic to yeast.

Lactobacillus acidophilus was trialled recently, or at least "a probiotic preparation of NONVIABLE L acidophilus" was. I nearly spilt my morning cup of coffee all over me when I read that! If it is nonviable then it isn't probiotic. End of story! Anyway, by definition (according to the World Health Organization), this was not a probiotic so I'm not quite sure what the study was about. It didn't achieve anything and I wouldn't have expected it to.

A number of probiotics such as Lactobacillus GG Lactobacillus plantarum 299v and Lactobacillus reuteri have trialled successfully against diarrhea in general but this does not mean they can do the job against the specific bugs that lurk on the highways and byways of your adventure package tour.

So - next time I get to travel somewhere exotic where I suspect a few of these bugs might be hanging out ready to become troublesome squatters in my gastrointestinal tract - this is MY plan of action.

• A month out, start working on having a really strong group of probiotics already installed. Eat more yogurt containing live and active culture, eat more fruit and vegetables with skins on and more green leafy things (all good places to gobble up a few unsuspecting probiotics.) Make it difficult for bad bugs to find a bit of untaken real estate.

• Start a course of Saccharomyces boulardii before leaving home.

• Wash my hands a lot more thoroughly than I bother to at home. No need to give the bad bugs a helping hand into your mouth.

• Check where all food and drink has come from. Take much more care than I would at home. You really DON'T know where they've been!

• Have a packet of rifaximin in my back pocket - just in case!

1.DuPont HL. Travellers' diarrhoea: contemporary approaches to therapy and prevention. Drugs 2006; 66(3):303-14

2.DuPont HL, Jiang ZD et al. A randomized, double-blind, placebo-controlled trial of rifaximin to prevent travelers' diarrhea. Ann Intern Med 2005 May 17;142(10):805-12

3.Kollaritsch H, Holst H, Grobara P, Wiedermann G. Prevention of traveler's diarrhea with Saccharomyces boulardii. Results of a placebo controlled double-blind study. (In translation from German) Fortschr Med 1993 March 30;111(9):152-6

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