BRUCE ROSEMAN, M.D.
330 WEST 58th Street .# 408    NY NY 10019
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New Telephone: (212) 957-8256  Cell/VM  1-917-414-3201
New Fax: (212) 265-2616
Hospital:  Mt. Sinai  (click for info)
BRUCE ROSEMAN, M.D.
NICOLE LIVESCU, R.N.
THE TRAVELER'S DIARRHEA HANDOUT

This page of instruction is meant to be an aide to the prevention and treatment of travelers diarrhea.  I suggest you print this page and bring it with you.

In the event you become sick there is even a minimal level of concern I would encourage to seek the advice of a physician in your locale and, or, call me.

I encourage you to call me  phone work all over the world, do not cost more than other phones and are something to be considered to stay in contact.
and discuss your situation and any treatment initiated especially when in underdeveloped countries.  Certain cell phones such as the Nokia world
HOW TO AVOID GETTING TRAVELERS DIARRHEA.
Take 2 tablets of pepto bismol 4 times per day
Start one day before your trip and continue until two days after you return.

DIARRHEA-AFTER YOU GET IT.
The single most important thing for you to remember is that while diarrhea is extremely unpleasant it is actually the resulting dehydration that is most harmful  and may even cause death.

Preventing dehydration is a simple yet monumental task. You simply have to take in more fluids and electrolytes that you put out.  That usually entails about 5 or more quarts of liquid per day.

Electrolyte solutions are the best fluids to drink, Gatorade, Powerade or others are sold here and Pripps plus in other countries.  Gatorade can be purchased in powder form in cans in most supermarkets and hiking shops such as EMS often have travel packets of the powder for purchase. I strongly recommend that you bring along some of this powder.
If you get stuck without and electrolyte solution here is one you can make yourself.

ORAL HYDRATION SOLUTION
Prepare 2 glasses and drink them alternately.
Glass 1 
8 oz. Orange apple or other fruit juice rich in potassium
teaspoon honey or corn syrup
pinch of salt
Glass 2   
8 oz. Water
  teaspoon baking soda(sodium bicarb)

ANTIBIOTICS
It has been shown that it is possible to decrease the chances of getting travelers diarrhea by taking antibiotics.  Numerous drugs are effective such as bactrim, tetracycline and cipro and others. If you want to take these drugs prophylactically call me to discuss it.  A more reasonable approach is to take the drugs if you get the diarrhea.  I suggest Cipro 500 mgs taken two times per day.

ANTI diarrhea medications.
Lomotil is the best.  It should be taken on an as needed basis.  This means take one and if it works do not take another unless you get diarrhea again.  You may have to take 1 tablet every 6 or 8 hours or in severe cases 2 tablets every 6 or eight hours.

Codeine can be bought in many places over-the-counter though not in the USA and this is extremely good for diarrhea 30-60 mgs every 6 hours as needed. It is the component in Tylenol #3 and vicodin.

Imodium is also over the counter and works well.

I strongly encourage you to look up all medication on Medline on my website www.brucerosemanmd.com  so that you are well versed in possible side effects.

Finally. If you are reading this note you are going somewhere which should be fun and I wish you a happy and healthy time and hope you will drop me a postcard.



Drug That Treats Diarrhea May Prevent It
A drug already used to treat that tourist nightmare traveler's diarrhea may also prevent it without causing the antibiotic resistance that can eventually make medicines ineffective, new research suggests.

The study showed that the antibiotic rifaximin prevented the troublesome condition in about 85 percent of the people who took it.

The experiment involved 210 American students studying Spanish in Guadalajara, Mexico, during the summer of 2003. Just under 15 percent of the students who took rifaximin for two weeks suffered from diarrhea, while nearly 54 percent of those who took placebos came down with the illness, which also includes nausea, vomiting and stomach pain.

Antibiotics have been used for years to treat traveler's diarrhea because it is caused by bacteria found in local food and water. Last year, the Food and Drug Administration approved rifaximin as a treatment for the illness.

But the study to be published Tuesday in the Annals of Internal Medicine suggests it's an effective preventive step as well.

"People who get decked all the time (by traveler's diarrhea) tend not to travel," said lead author Dr. Herbert DuPont, of the University of Texas Health Science Center in Houston and chief of internal medicine at St. Luke's Episcopal Hospital. "This would allow these people to enjoy a traveling life."

Traveler's diarrhea affects about 20 million international travelers a year, DuPont said. And about 40 percent of those have an extra genetic susceptibility that means they get no relief from over-the-counter treatments such as Pepto-Bismol.

Dr. Phyllis Kozarsky, a professor of medicine and infectious diseases at Emory School of Medicine in Atlanta, said doctors generally don't like to prescribe antibiotics as a preventive measure.

But, she said, rifaximin would be a good idea for people whose immune systems are compromised, who are traveling to developing countries for special events and can't afford the risk of being downed by diarrhea, and for people "who travel frequently to Mexico and once they get on the plane, think, 'Oh, gee, it's just a matter of time.' "

A future study will focus on Thailand, where the bacteria that can cause diarrhea is more invasive than that found in Mexico, DuPont said.

"We have every reason to think it'll work in Asia," he said.

While a germ can become resistant to an antibiotic that is overused, the researchers believe rifaximin has properties that make it unlikely to cause resistance.

Rifaximin is marketed by Salix Pharmaceuticals of Raleigh, N.C., under the name Xifaxan. Salix helped fund UT's study, and DuPont and some of his colleagues on the study have worked as consultants to the drug maker.