Traveler's diarrhea travel

Traveler's diarrhea (TD) is the most common illness affecting people who travel internationally. It is caused by eating food or drinking water that is contaminated with bacteria, viruses, or parasites. US travelers heading to destinations in Latin America, Africa, Asia, and the Middle East face the highest risk, especially when visiting areas where food safety standards differ from those at home.

How to prevent traveler's diarrhea

There is no approved vaccine for traveler's diarrhea in the United States. Prevention relies on a combination of careful food and water choices and, in some cases, preventive medication. The most important rule is to avoid tap water, ice made from tap water, raw vegetables, undercooked meat, and food sold by street vendors in high-risk areas. Stick to bottled water, hot cooked foods, and fruits you peel yourself.

Bismuth subsalicylate (the active ingredient in Pepto-Bismol) can reduce the risk of getting TD when taken before and during travel, according to NIH StatPearls. Frequent handwashing with soap and water, especially before eating, is also one of the most effective steps you can take. For travelers at higher risk, such as those with weakened immune systems or inflammatory bowel disease, a travel health provider may consider antibiotic prophylaxis (preventive antibiotics), though this is not recommended for most travelers, per the CDC. Talk to a provider before your trip to decide what prevention plan is right for you.

WayPax Health recommendation

WayPax Health stocks a dedicated Travelers Diarrhea Kit that includes ciprofloxacin 500 mg, azithromycin 500 mg, and metronidazole 500 mg, along with loperamide and bismuth subsalicylate from the GI Kit. This combination covers bacterial TD (the most common type), protozoal infections like Giardia, and provides symptom relief while treatment takes effect. Azithromycin is the preferred antibiotic for travelers heading to Southeast Asia, where resistance to other antibiotics is more common. Whether you are a backpacker, a business traveler, or a family visiting relatives abroad, having a TD kit prescribed before you leave means you can start treatment the moment symptoms begin, without scrambling to find a pharmacy overseas. WayPax providers can review your full itinerary, discuss all your prevention options, and write a real prescription entirely online, giving you the same care you would get at a traditional travel clinic without ever leaving your home.

Get your Traveler's Diarrhea prescription and other travel medicines online today.

What is traveler's diarrhea?

Traveler's diarrhea is a digestive illness that causes loose or watery stools, stomach cramps, nausea, vomiting, and sometimes fever. Research published in PMC notes that symptoms typically last 2 to 4 days and can include urgent trips to the bathroom, stomach pain, and in some cases bloody stools. The illness is most often caused by bacteria, with enterotoxigenic Escherichia coli (ETEC, a type of E. coli that produces toxins in the gut) being the most common culprit. Other causes include Campylobacter, Shigella, and Salmonella bacteria, as well as parasites such as Giardia and Entamoeba, according to the CDC.

TD spreads through contaminated food and water. Symptoms usually begin within 6 to 72 hours of eating or drinking something contaminated. Most cases resolve on their own within a few days, but dehydration (losing too much fluid from your body) is the main concern, especially in hot climates. The WHO and clinical reviews from NIH both emphasize that replacing lost fluids quickly is the most important first step in managing the illness.

Where is traveler's diarrhea a risk?

Traveler's diarrhea is a concern in many parts of the world, but the risk is not equal everywhere. Destinations are generally grouped into three levels based on how common TD is among visitors, as outlined by the CDC.

High-risk regions include most of sub-Saharan Africa, South Asia, Southeast Asia, Central America, and parts of South America and the Middle East. In these areas, a significant portion of travelers will develop TD, particularly during the first two weeks of their trip. The risk is highest in places where water treatment infrastructure is limited and food handling practices vary widely.

Intermediate-risk regions include parts of Eastern Europe, South Africa, and some Caribbean islands. Travelers to these areas face a moderate chance of getting TD, especially if they eat outside of established restaurants or consume tap water.

Low-risk regions include Western Europe, Australia, New Zealand, the United States, Canada, and Japan, where water and food safety standards are generally high. TD can still occur in these places, but it is far less common among visitors. Seasonal factors such as heat and humidity can increase bacterial growth in food, making warm-weather travel to high-risk regions particularly risky.

Treatment: what to do if you get traveler's diarrhea

The first and most important step when TD strikes is to replace fluids. Drink plenty of clean water or oral rehydration salts (ORS), which are packets you mix with water to restore the electrolytes your body loses. Loperamide (Imodium) can reduce the number of loose stools and is approved for short-term use in TD, according to a clinical review in PMC. Do not use loperamide if you have a fever or bloody stools.

For moderate to severe TD, antibiotics are the standard treatment. Guidelines published in PMC recommend azithromycin as the preferred antibiotic, particularly in Southeast Asia. Ciprofloxacin is another option for bacterial TD in other regions. If symptoms last more than 2 weeks or include blood in the stool, high fever, or signs of severe dehydration such as dizziness or very dark urine, seek medical care right away. A travel health provider can help you choose the right antibiotic before you leave home so you are ready to treat TD the moment it starts.

Frequently asked questions

What are the symptoms of traveler's diarrhea in travelers?

The most common symptoms are loose or watery stools, stomach cramps, nausea, and an urgent need to use the bathroom. Some travelers also experience vomiting, bloating, and a low fever. Symptoms usually begin within a day or two of exposure and can last anywhere from 2 to 4 days without treatment.

How can I prevent traveler's diarrhea when I travel?

The most effective steps are to avoid tap water, ice, raw vegetables, undercooked meat, and food from vendors with uncertain hygiene. Wash your hands often with soap and water before eating. Bismuth subsalicylate (Pepto-Bismol) taken before and during travel can also lower your risk. For higher-risk travelers, a provider may prescribe preventive antibiotics.

Can I get traveler's diarrhea from food or water abroad?

Yes. TD is almost always caused by eating food or drinking water that has been contaminated with bacteria, viruses, or parasites. Even small amounts of contaminated water, such as what you might swallow while brushing your teeth, can be enough to cause illness. Choosing bottled water and well-cooked foods is the best way to lower your risk.

How do you treat traveler's diarrhea while traveling?

Start by drinking plenty of fluids or oral rehydration salts to replace what you are losing. Loperamide can help slow diarrhea for mild cases. For moderate or severe TD, antibiotics such as azithromycin or ciprofloxacin are the standard treatment. The best approach is to have a TD kit prescribed before you leave so you can start treatment immediately without searching for a pharmacy abroad.

Where is traveler's diarrhea most common for travelers?

TD is most common in sub-Saharan Africa, South Asia, Southeast Asia, Central America, and parts of South America and the Middle East. These high-risk regions have the highest rates of TD among visiting travelers. Intermediate-risk areas include parts of Eastern Europe and the Caribbean. Low-risk destinations include Western Europe, Australia, and Japan.

Should I take medicine for traveler's diarrhea before I travel?

Most travelers do not need to take antibiotics before their trip as a preventive measure. However, bismuth subsalicylate can be taken before and during travel to reduce your risk. Travelers with certain health conditions, such as a weakened immune system, may benefit from a preventive antibiotic prescription. The best step is to speak with a travel health provider before you leave. WayPax Health providers can review your itinerary and health history online and write a real prescription for a TD kit so you are fully prepared before you board your flight.

Explore by region

Latin America and the Caribbean

• Guatemala
• Ecuador
• Peru
• Haiti
• Dominican Republic
• Guyana
• Trinidad and Tobago
• Antigua and Barbuda
• Saint Vincent and the Grenadines

Sub-Saharan Africa

• Kenya
• Ethiopia
• Cameroon
• Guinea
• Gambia
• Togo
• Gabon
• Democratic Republic of the Congo
• Somalia
• Eritrea
• Equatorial Guinea
• Sao Tome and Principe

South and Southeast Asia

• India
• Nepal
• Laos
• China
• Timor-Leste

Middle East and North Africa

• Jordan
• Lebanon
• Syria
• Algeria
• Tunisia
• Qatar

Eastern Europe and Central Asia

• Turkey
• Georgia
• Russia
• Turkmenistan

Related diseases

• Cholera, a severe waterborne illness also caused by contaminated food and water in many of the same high-risk regions
• Typhoid fever, a bacterial infection spread through contaminated food and water, common in South Asia, Africa, and Latin America
• Hepatitis A, a liver infection spread through contaminated food and water that affects travelers to many of the same destinations
• Norovirus, a highly contagious stomach illness spread through contaminated food, water, and surfaces, including on cruise ships
• Giardia, a parasitic infection of the gut spread through contaminated water, common in developing regions worldwide