Montezuma's Revenge & Amoxicillin

[traveltina]

I have a question related to the dreaded condition of Traveler’s Diarrhea. I have had an extreme phobia of it ever since it ruined my trip to Roatan in 2001.

My dermatologist just gave me a prescription for 500mg (1x a day) of Amoxicillin for my acne. This is a prescription that I would continue to take for a while - several months at least. I want to start taking it but then I started thinking about the effects it might have on our Costa Rica trip at the end of March.

I know that when you take an antibiotic it kills the good bacteria in your digestive tract – sometimes causing diarrhea. If this increases my chances of Traveler’s Diarrhea then I can hold out and not start taking the Amoxicillin until after our trip.

But then – I also have heard that Doctor’s sometime prescribe antibiotics to treat Traveler’s Diarrhea – so if I am on the Amoxicillin throughout our trip would that help or hurt my chances of getting sick.

Thanks!
Tina

 

[DivePartner1]

A recent Univ. of Houston (?) study published in Undercurrent linked this to dirty hands of food preparers, not 'the water." Yuck. I'm not sure what can be done to defend against this.

 

[DocVikingo]

It's not quite that simple.

Traveler’s diarrhea (TD) is largely the result of just a few microbial culprits. More than 80% of the cases result from ingesting liquids & foods contaminated by either human or animal fecal matter. While it is usually caused by one of a number of bacteria, most often E. coli, it can also be brought on by parasites & viruses, and from greasy, fatty & spicy foods, and items you are not used to eating.

While unwashed hands, both those of food preparers & your own, indeed may spread causes of TD that is not the only way. You most assuredly can get it from contaminated water.

A detailed coverage of TD can be found in the Apr '02 issue of Undercurrent http://www.undercurrent.org/

Best regards.

DocVikingo

PS: The study you have referred to is in the Sep '02 issue of Undercurrent http://www.undercurrent.org/ as well as the New Scientist http://www.newscientist.com/

 

[nitroxbabe]

A little personal experience...

I have been taking antibiotics long-term for a chronic problem. I drink acidophilus milk, eat lots of yogurt and also sometimes supplement with acidophilus/bifidus (available in the refrigerator section of your local health food store). The goal here is to replace the friendly microbes that the antibiotic kills. You may want to consider this while on the antibiotics, and especially after you stop them - it helps!

 

[Norda]

Traveltina,

Don't forget about the effects of antibiotics and Sun exposure. Some people have a terrible reaction, which can really be miserable. Not sure how much of a concern this is with Amoxicillin but would probably be wise to check with a pharmacist.

Bill.

 

[DivePartner1]

Thanks, Doc! Is there anything we can get other the counter as a preventative?

 

[traveltina]

Thanks Doc. That is funny that you mention that article in Undercurrent April '02 - because I believe that is the one that I was quoted in - about our trip to Roatan.

So in your opinion - do you think I would be better to not take the antibiotic until I get back? Let's say I did eat something that was contaminated with some sort of bad bacteria - would the antibiotic help - or would it hurt because I wouldn't have any good bacteria to kill it off.

I know this is not cut and dry - but ever since Roatan I have been researching TD like crazy. My husband just wants me to relax while we are traveling - but I am always thinking of the possibilites of something being contaminated. "Don't eat that" has become my favorite phrase. But the more I research it the more I realized that even if you are careful - you just don't have much control on other aspects - like the sanitary habits of the food preparer's etc...
I did take a acidophilus/bifidus supplement before our last 2 trips - and forced my husband to also.

Thanks for the sun warning Norda - I will definitley be bring some '45!

 

[DocVikingo]

Use of preventative medication typically is only recommended when the probability of TD is high, or when its occurence poses a significant threat to health.

Under many circumstances, the preventative steps outlined in my Undercurrent article will provide adequate protection, i.e., be cautious about food & drink, and frequently wash your hands. While most travelers focus on ensuring the fluids they drink are pure, food-borne pathogens are the number one cause of infection. Eat only fruits and vegetables that have been thoroughly cooked, or at least peeled & cleaned. Shy away from leafy greens that are difficult to wash thoroughly. Stick with recently and well-cooked items served very hot. Avoid raw foods such as seviche and shellfish, and undercooked meat or fish. Pass on the street vendors and eateries that appear unhygienic.

Major resorts and restaurants in higher risk areas often use purified tap water or serve bottled water. Live-aboards, with properly maintained desalinization systems, produce potable water. If in doubt, ask. And don’t forget to ask about the ice in your drinks. Bottled beverages like soda are generally safe, but avoid products like milk and beer if they are not pasteurized, and fresh fruit juices sold at roadside stands.

If one needs to take something, probably the best OTC product for this is Pepto Bismol, which should be used only as directed. Other measures can be added later if TD takes hold despite this prophylaxis.

Best regards.

DocVikingo

 

[DocVikingo]

You are correct that it's not cut & dried.

1. (Q) "Let's say I did eat something that was contaminated with some sort of bad bacteria - would the antibiotic help - or would it hurt because I wouldn't have any good bacteria to kill it off."

(A) It would help only if the bacteria you tangle with is susceptible to the particular antibiotic you are taking. If it's not, likely the drug would only make things worse.

While Amoxicillin is generally well tolerated, diarrhea/loose stools is the most commonly reported side effect.

As an aside, Amoxicillin is not among the first line antibiotics prescribed for either the prevention or treatment of TD.

2. (Q) "So in your opinion - do you think I would be better to not take the antibiotic until I get back?"

(A) If I was considering taking Amoxicillin for uncomplicated acne, I'd discuss with my dermatologist the advisability of delaying this treatment until my dive trip was completed.

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

Best regards.

DocVikingo

PS: Norda's advice regarding the sun is no doubt well-meaning, but not accurate. While some classes of antibiotics do require one to take especial precautions to avoid sun exposure, I do not believe that the class to which Amoxicillin belongs is one of them.

 

[Norda]

Doc,

I would hope that my suggestion to check with a pharmacist is accurate?