Best Medications for Montezuma’s Revenge (Traveler’s Diarrhea)

Traveler’s diarrhea is a common illness among international travelers. According to the Centers for Disease Control and Prevention (CDC), it affects 30-70% of Americans on a trip abroad to high-risk areas, such as developing countries in Latin America, South America, the Middle East, Africa, South Asia, and Southeast Asia. Indeed, traveler’s diarrhea is sometimes called Montezuma's Revenge because it frequently afflicts travelers to Latin America.

While traveler’s diarrhea is usually a mild illness that lasts about a day or two, it can sometimes be severe, requiring treatment. Please keep reading to find out which medications are used to treat traveler’s diarrhea and relieve symptoms.

What causes traveler’s diarrhea?

Traveler’s diarrhea is classified as a type of infectious diarrhea. It is commonly known as food poisoning, which occurs as a result of poor hygiene practices by street vendors and food handlers in local restaurants abroad. Some of the common infectious organisms that can cause traveler’s diarrhea include:

Bacteria: Escherichia coli (E. coli), Campylobacter jejuni, Shigella, and Salmonella are the most common cause
Viruses: norovirus, astrovirus, and rotavirus can also cause travelers diarrhea
Parasites: Giardia

How do you get traveler’s diarrhea?

You can get travelers diarrhea from consuming contaminated food and water. Contamination often takes place in the process of food handling and preparation. Environmental factors play a significant role in the transmission of traveler’s diarrhea. In developing countries, the rate of contamination is a lot higher due to inadequate plumbing systems. Warm climates, an optimal environment for flies to reproduce, along with a lack of electrical capacity can lead to unsafe food storage, as refrigeration may not be widely accessible. Lack of water supply and inadequate resources to purify tap water are a few other factors that may contribute to traveler’s diarrhea.

It was traditionally believed that you could protect yourself from traveler’s diarrhea by eating cooked foods and drinking boiled water or bottled beverages (bottled water). Avoiding uncooked vegetables, raw meats, tap water, and unpasteurized milk are other tips to remain healthy while traveling. However, many travelers who follow these guidelines still become ill with diarrhea due to E. coli bacteria or other germs.

What are the symptoms of traveler’s diarrhea?

Traveler’s diarrhea typically manifests as a sudden onset of urgent loose stools and mild cramps, often within hours of eating contaminated food. In more severe cases, symptoms can include severe abdominal pain, nausea, vomiting, bloody diarrhea, and fever.

How long does Montezuma’s revenge last?

Traveler’s diarrhea caused by viruses is typically a short-lived illness, lasting 2-3 days on average. Bacterial traveler’s diarrhea can last for 3-7 days. Protozoal diarrhea can last for weeks to months if it is not treated.

What medicine helps with traveler’s diarrhea?

Oral Rehydration Solution (ORS)

The best treatment for traveler’s diarrhea is a replacement of the electrolyte and fluid loss caused by diarrhea and vomitting. Fluid replacement is especially important in young children and adults with chronic medical conditions who are at higher risk of complications. However, even healthy young adults can develop severe dehydration from prolonged vomiting and diarrhea.

The pre-prepared oral rehydration solution (ORS) is an over-the-counter medication recommended by the World Health Organization. It contains essential salts and is widely available in developing countries. You should prepare the ORS by adding the contents of one packet to 1 liter of boiled or purified water (check the label for instructions). Continue to eat foods along with rehydration because solid foods are needed to keep your energy levels up.

For oral rehydration with fluids, make sure you do not drink tap water. Use only bottled beverages or purified water to rehydrate. Avoid caffeine, which can be dehydrating. Also, avoid sugary drinks and dairy products, which can sometimes make diarrhea worse. Even though sports drinks may contain sugar, people with mild cases of traveler’s diarrhea can still use sports drinks if they can’t tolerate the taste of ORS. Additionally, avoid ice cubes as they may not be made from clean water.

Bottle-fed infants should be given 1-2 ounces of fluid every 30 minutes. You can continue nursing breastfed infants. It’s important to seek immediate medical attention from a healthcare professional if infants or older children have a fever with persistent vomiting and diarrhea.

Antimotility Drugs

Some medications help to relieve symptoms of traveler’s diarrhea by reducing motility in the gastrointestinal tract and thereby reducing the frequency of bowel movements. These medicines can be used for treating traveler’s diarrhea. Examples of medicines that reduce intestinal tract motility include loperamide (Imodium) and diphenoxylate/atropine (Lomotil). Antimotility drugs work to reduce the frequency of bowel movements, which is very useful for airplanes or bus rides.

Antimicrobial Agents

Antimicrobials like tinidazole, metronidazole, nitazoxanide and trimethoprim- sulfamethoxazole (Bactrim) are treatment options for travelers' diarrhea caused by parasites or protozoans.

Do antibiotics help Montezuma's revenge?

A mild case of Montezuma’s revenge or traveler’s diarrhea is a self-limited illness that does not usually require antibiotics. However, more severe cases of traveler’s diarrhea may require antibiotic treatment.

Fluoroquinolones, such as ciprofloxacin or levofloxacin, are the most effective antibiotics for the treatment of bacterial traveler’s diarrhea. Other options include azithromycin, rifamycin SV, and rifaximin.

Some people are at increased risk of infection and may need prophylactic antibiotics to prevent traveler’s diarrhea. However, taking antibiotics to prevent traveler’s diarrhea is no longer recommended for most travelers. This is because antibiotics do not protect against viral infections. Also, antibiotic over-usage can eliminate good bacteria from the gut and increase the risk of severe diarrhea caused by Clostridium difficile (C. diff) bacteria. Moreover, the emergence of antibiotic resistance has made it important to use antibiotics only when appropriate and as instructed by healthcare professionals. Overuse of antibiotics can reduce the effectiveness of antibiotics against certain bacteria. Lastly, antibiotic use can cause allergic reactions and unpleasant side effects in some individuals.

Instead of using antibiotics to prevent traveler’s diarrhea, doctors recommend early treatment with antibiotics for moderate to severe illness. This can help to lessen the severity and duration of the traveler’s diarrhea.

Is Pepto Bismol good for Montezuma's revenge?

Bismuth subsalicylate, the active ingredient in Pepto-Bismol and Kaopectate, has been found to reduce the occurrence of traveler’s diarrhea by about 50%. The recommended dose of Pepto-Bismol is 2 chewable tablets or 2 oz of liquid four times a day.

Possible side effects of bismuth subsalicylate include blackening of the tongue and stools, nausea, constipation, and ringing in the ears.

People with an aspirin allergy, gout, and renal insufficiency, and those taking blood thinners, methotrexate, or probenecid should not take bismuth subsalicylate. Also, this medicine is not usually recommended for children less than 12 years of age and pregnant women.

Can probiotics prevent traveler’s diarrhea?

It is unclear if probiotics like Saccharomyces boulardii and Lactobacillus GG can help prevent travelers' diarrhea. There is no strong scientific evidence that bovine colostrum can prevent traveler’s diarrhea. Keep in mind that this is a supplement and is not approved by the FDA to treat traveler’s diarrhea.

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