Most Common Travel Sicknesses: What To Do By Doctor-Pharmacist Duo

What would you do if you fell ill while traveling abroad without access to medical care, with a language barrier to boot? Nobody wants to make national headlines for diverting a plane due to diarrhea. I can’t even fathom that nightmare…

We are here to share educational information, help you be prepared, and learn about the most common travel illnesses.

In each section we discuss causes of the symptoms, treatment options, when to seek medical care, and which medications we recommend to pack for prevention.

Amanda (the country spouse) is a Doctor of Pharmacy and clinical pharmacist with work experience in the emergency department, retail and long-term care pharmacy.

Seth (the city spouse) is a Doctor of Medicine and a board certified emergency medicine physician from Washington University in St Louis School of Medicine completing residency there, and at Barnes-Jewish Hospital and St Louis Children’s Hospital.

In this blog, we are not referring to special populations such as pregnant women, children, elderly, or those with significant chronic disease states. This is for the average healthy adult traveler. Keep an eye out for future blogs discussing special populations.

Comment below with any questions or content suggestions for us!

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Before your next traveling adventure, consider packing some of the medications we will discuss in this blog. Being prepared when sudden illness strikes is the optimal strategy. You will thank yourself if you become unwell far from the comfort of your home!

If you are currently traveling and found us by googling your symptoms in a panic, here are some options: Ask the hotel’s front desk if there is an onsite medical office or nurse, go to a nearby pharmacy, or seek treatment at a clinic/hospital if you’re experiencing a medical emergency.

1. Diarrhea

Diarrhea is the most common illness experienced by travelers. It is NO fun to be hit with the urge “to go” on a plane or boat—so let’s help you be prepared!

The most common causes of diarrhea in the average population are viral, such as rotavirus. The course of illness is usually self-limiting, meaning it will resolve on its own without medical intervention.

Remember, this is meant for travelers who could be stuck in a situation without a bathroom. Allowing your body to naturally expel toxins is ideal by letting diarrhea run its course when applicable.

Non-prescription treatment for diarrhea:

• Loperamide – commonly sold as “Anti-diarrheal” and “Imodium”.
  • Most effective over the counter anti-diarrheal.
  • I do not travel without loperamide in my purse.
  • Very fast acting, even longer lasting.
  • Comes in tablets, liquid, and soft gels.
  • Ask pharmacist for drug interaction check.
  • *UNSAFE for ages 2 and younger. Ask pediatrician for kids.*
  • *Caution in patients with heart related diseases.*
• Bismuth Subsalicylate – commonly sold as “Pepto-Bismol”, “Kaopectate”, and “Stomach Relief”.
  • Alternative to loperamide, avoid using both meds for diarrhea.
  • Can turn stools harmlessly black. (See our YouTube video below for dangers of black/bloody stools.)
  • Off-label use to treat AND prevent travelers diarrhea.
  • Travelers diarrhea prevention dose is 524 mg four times daily.
  • *Not safe for kids because ingredient is similar to aspirin, especially if kids have flu like symptoms—Reye’s Syndrome.*
• Simethicone – commonly sold as “Gas Relief” and “Gas-X”.
  • Available as chewable tablets, capsules, and drops.
  • Relives discomfort caused by gas pains and bloating.
  • Can be used with anti-diarrheal mediation.
• Probiotics – many products are available for OTC purchase.
  • “Florastor” and Walgreens brand “Daily Probiotic” are two great options with S. Boulardii probiotic strain for travelers diarrhea.
  • Replaces the good bacteria needed for a healthy gut.
  • Can decrease course of illness by 1 to 1.5 days!
  • *Caution in immune compromised patients.*
  • Can take with anti-diarrheal or use as solo agent if able to let diarrhea run its course.
  • Pricey. Yogurt can be tried instead (dairy is usually avoided in diarrhea but probiotics in yogurt may help.)
• Hydration – the single most important tip for managing diarrhea.
  • Sip small amounts of clear liquid, frequently!
  • Pedialyte (Yes, for adults too). Single-use packets are available and more travel-friendly than the liquid.
  • Basic DIY “oral rehydration solution” recipes exist online. Most include boiled water, salt, and sugar.

Avoid common causes of diarrhea:

• Keep hands washed frequently.
• Travel with hand sanitizer (for when soap and water isn’t available).
• Avoid ingesting tap water, uncooked food, and ice without knowing if its safe to consume.
• Check the CDC website to know where Rotavirus is prevalent.

When to seek medical treatment for diarrhea:

• Symptoms lasting more than 48 hours.
• High fever of 102°F (38.9°C) or greater.
• Severe abdominal pain.
• Loss of consciousness.
• Bloody or dark tarry stools.
• Signs of severe dehydration such as dizziness, extreme thirst, decreased urination, or fast heart beat (more than 100 beats per minute).

Medications we most recommend packing for prevention/management of diarrhea when traveling:

• Loperamide
• Probiotics
• Hydration/electrolyte tablets or packets

See our YouTube video below for more in-depth information and tips about diarrhea when traveling, causes, when to seek medical care, and treatment discussion.

2. Nausea & Vomiting

The most common cause of infectious nausea and vomiting in the average population is once again—viral. This means antibiotics will not be effective in treating the cause of illness. A few common non-infectious causes include motion sickness, pregnancy, acid reflux, and migraines.

There are multiple prevention and treatment approaches for nausea and vomiting, but the most important while traveling is to slow down fluid loss and hydrate!

If you can anticipate events that will trigger nausea or vomiting, preventative medication could be ideal for you.

Non-prescription treatment options for motion related nausea and/or vomiting:

• First generation antihistamines – Most effective over the counter nausea/vomiting treatment and prevention from motion sickness.
  • Greater side effects than newer, second generation anti-histamines such as sedation and drowsiness.
  • Using a first generation is necessary for nausea/vomiting caused by motion sickness as they readily penetrate the brain.
  • *Caution if driving until you know how meds affect you.*
  • *Caution in elderly and patients with BPH, asthma, or glaucoma.*
  • Take dose per medication label 1 hour prior to travel to prevent symptoms.
  • Take dose as directed per medication label to treat symptoms.
    • Dimenhydrinate – also sold as “Dramamine Original Motion Sickness” and “Motion Sickness Relief”.
      • One study showed it to be more effective than a prescription Scopolamine patch for nausea.
    • Diphenhydramine – also sold as “Benadryl” and “Allergy Relief”. Fast onset of action.
    • Meclizine – also sold as “Dramamine Nausea”, “Dramamine Motion Sickness Less Drowsy”, “Bonine”, and “Nausea Relief”. Often prescribed for vertigo.
      • Often advertised as “once a day” dosing due to its 8-24 hour duration of action.
      • Dosing is typically 12.5-100 mg daily or divided doses based on indication and symptoms.
      • *Follow your doctor’s instructions or label for dosing.*
      • Less effective than others in class (and prescription Scopolamine) but also less sedating.
    • Doxylamine – also sold as “Unisom” or “Sleep-Aid”. Used in pregnancy related nausea and vomiting.

Non-prescription treatment options for indigestion or food related nausea and/or vomiting:

• Bismuth Subsalicylate – also sold as “Pepto-Bismol” or “Kaopectate”.
  • Used for stomach upset or nausea related to indigestion or stomach acid.
  • Can turn stools black.
  • *Not safe for kids because ingredient is similar to aspirin, especially if kids have flu like symptoms—Reye’s Syndrome.*
• Calcium Carbonate – also sold as “Tums” or “Antacid Tablets”.
  • Good for nausea caused by stomach acid or over eating.
  • Non-drowsy option for nausea.
  • Favorable side effect profile. Well tolerated.

Non-prescription treatment options for suspected infectious related nausea and/or vomiting:

• Phosphorated Carbohydrate Solution – also sold as “Emetrol”.
  • Available as liquid or chewables.
  • Calms muscle contractions of the stomach.
  • Is a non-drowsy option for nausea or vomiting.
  • Do not take more than 5 doses in 1 hour.
  • Do not take with fluids to avoid diluting dose.
  • Caution if diabetic, Emetrol is made with dextrose which is a sugar.
  • Good for nausea or vomiting related to stomach flu or food/drink intolerances.

Non-prescription treatment options for any type of nausea and/or vomiting:

• Ginger – several products contain ginger such as “Dramamine Non-Drowsy Naturals”.
  • Available as ginger chews, ginger gum, and ginger ale soda.
  • Non-drowsy option for nausea or vomiting.
  • Can be taken in addition to other anti-nausea medications.
  • Mechanism thought to be similar to prescription medication called Zofran for nausea but is poorly understood.
  • Caution in elderly; suggested to possess anticholinergic effects.
  • Consult pharmacist for potential drug interactions if on blood thinners or blood pressure medication.
• Hydration – sip small amounts of clear liquid frequently.
  • Pedialyte for the win again!
  • Basic DIY “oral rehydration solution” recipes exist online. Most include boiled water, salt, and sugar.

When to seek medical attention for nausea and/or vomiting:

• Vomiting lasts more than 48 hours.
• Vomiting accompanied by severe headache or confusion .
• High fever of 102°F (38.9°C).
• Vomiting blood or looks like coffee grounds.
• Signs of severe dehydration such as dizziness, extreme thirst, decreased urination, or fast heart beat (more than 100 beats per minute).

Medications we most recommend packing for preventing or treating nausea/vomiting (N/V) when traveling:

• Meclizine or Dimenhydrinate for N/V caused by motion sickness.
• Emetrol for all N/V that is not caused by motion.
• Ginger gum or chews for N/V of any cause.
• Hydration/electrolyte tablets or packets for N/V of any cause.

3. Sunburn

Well this one has probably happened to all of us. Sunburns are a quick way to ruin vacation because they can be extremely painful.

Most of us are aware of the cancer risk from sun exposure. But how about the risk of infections such as cellulitis caused by sunburns? Yikes!

Preventing sunburns is the key to a safe vacation for all ages:

• Sunscreen – a minimum of SPF 30, “broad spectrum” for both UVA and UVB protection, and water resistant will provide the most protection.
  • The difference between SPF 30 and SPF 100 can be misunderstood, creating a false sense of safety.
  • SPF 30 blocks 97% of UVB radiation, SPF 50 blocks 98%, and SPF 100 blocks 99%.
  • Higher SPF does not mean longer lasting!
  • Reapplying sunscreen often provides the most protection.
  • Sunscreen that isn’t “reef-safe” could be banned in your destination. We recommend being kind to marine life and using it if possible. 😊
• Apply sunscreen at least 15 minutes before sun exposure for adequate drying.
• Reapply sunscreen every 2 hours, and after swimming, toweling, or sweaty activities.
• Wear SPF gear or protective clothing, hats, and eyewear.
• Avoid prolonged sun exposure during peak hours of 10a-4p (or 10a-2p depending on the source).

Non-prescription treatment and management for pesky sunburns:

• NSAIDs – such as “Ibuprofen” (also sold as “Motrin”, or “Advil”).
  • Great for easing inflammation related pain.
  • Take with food to avoid stomach irritation and nausea.
  • *Caution in heart failure, kidney disease, known bleeding risks, cirrhosis, and other chronic conditions that pose a risk with NSAID use.*
  • *Caution if you have a known bleeding risk such as taking blood thinners, have a history of ulcers or GI bleeds.*
  • Ibuprofen dose for healthy adults is 200 to 400 mg every 4-6 hours as needed for symptoms.
  • Max daily dose of Ibuprofen for healthy adults is 3,200 mg per day.
• Aloe Vera Gel – water-based topical cooling and soothing gel.
• Calamine Lotion – helps soothe itch caused by sunburn.
• Moisturizer – use gentle moisturizer such as “CeraVe” for several days following a sunburn to keep skin cool and moist.
  • Avoid petroleum or oil based products that trap heat in.
• Cool Compress – use cool wet towels or cool baths for sunburn relief.
  • Avoid putting ice directly on the skin.
• Hydration – our old friend—we meet again! Staying hydrated after any burn, even a sunburn, is recommended to avoid complications.

When to seek medical attention for sunburns:

• Blistering over a large portion of your body (more than 20%).
• Severe swelling.
• Extreme pain.
• Fever (greater than 100.4°F or 38°C), chills, and/or nausea.
• Signs of infection (pus from blisters).
• Signs of dehydration such as dizziness, extreme thirst, decreased urination, or fast heart beat (more than 100 beats per minute).

Medications we most recommend packing for preventing or treating sunburns when traveling:

• Sunscreen SPF 30 or higher.
• Travel size aloe vera to keep in a hotel fridge.
• Hydration/electrolyte tablets or packets.

4. Fever

A fever is your body’s natural response to fight infection. Although uncomfortable (or downright miserable at times), a fever can actually be quite the beneficial tool against illness.

Common causes of fever for the average healthy adult are infectious illnesses, either viral or bacterial. A fever alone is not enough to distinguish between viral or bacterial infections. An exam by your provider is needed to decide if you need antibiotics to treat a bacterial infection.

While fevers are most commonly an indication of underlying infection, they have other important causes in travelers, most notably sun and environmental exposure.

When traveling abroad, a fever is certainly more worrisome. We will discuss managing symptoms for convenience and comfort only.

Remember, you are likely contagious. If possible, rest alone in a hotel room until 24 hours after your fever breaks.

Treatment for symptoms of fever with antipyretic (temperature reducing) medications could help you power through your situation while traveling, especially if your illness is self resolving.

Over the counter antipyretic medications to manage fevers:

• NSAIDs – class of medications including Ibuprofen, Naproxen, and Aspirin.
  • Ibuprofen is also sold as “Motrin” and “Advil”.
  • I never travel without Ibuprofen in every bag we pack (compliments of entering my 30’s).
  • Same precautions as mentioned in the sunburn section above.
  • *Caution in heart failure, kidney disease, cirrhosis, and other chronic conditions that pose a risk to NSAID use.*
  • *Caution if you have a known bleeding risk such as taking blood thinners, having a history of ulcers or GI bleeds.*
  • Recommended ibuprofen dose for healthy adults is 200 to 400 mg every 4-6 hours as needed for symptoms.
  • Max daily dose of Ibuprofen for healthy adults is 3,200 mg per day.
• Acetaminophen – is not an NSAID but is an antipyretic.
  • Acetaminophen is also sold as “Tylenol” or “Pain Reliever”.
  • A great alternative for patients who can’t take NSAIDs.
  • Recommended dose for healthy adults is 325-650 mg every 4 to 6 hours as needed for symptoms.
  • Max daily dose of Acetaminophen for healthy adults is 4,000 mg per day.
• Both Ibuprofen and Acetaminophen can be used together if your fever symptoms are unbearable.
  • Keep their dosing schedules the same as mentioned above.
  • Set an alarm or keep notes in your phone of last dose given to avoid doubling up on either medication.
• Rest, hydration, and nutritious foods are most important when you are sick.
  • Clear fluids, Pedialyte, or other electrolyte containing liquids can help prevent dehydration.
  • I know you are on vacation, but your body needs rest to heal.
  • Vitamins and minerals from your diet are essential to fueling our cells to do their jobs, and right now—they are working over time.

When to seek medical attention for a fever:

• Temperature greater than 103°F (39.4°C).
• Any fever lasting 3 days or more.
• Loss of consciousness.
• Stiff neck.
• Seizure.
• Painful urination.
• Severe headache.
• Difficulty breathing.
• Changes in mental status.
• Signs of severe dehydration such as dizziness, extreme thirst, decreased urination, or fast heart beat (more than 100 beats per minute).

Medications we most recommend packing for treating fevers when traveling:

• Ibuprofen (our top choice).
• Acetaminophen (for those unable to take ibuprofen, or using with ibuprofen for resistant fevers).
• Hydration/electrolyte tablets or packets.

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Thank you for reading our first blog of the travel medicine edition to this website.

We both hope you have learned something new and can better prepare to manage your symptoms should you become unwell during your vacation!

Please comment below with any questions you have for Seth or Amanda, or use the email forum. We love feedback and suggestions on future topics!

Subscribe to this website to be notified of upcoming blogs including Common Travel Sicknesses Part 2.

-Amanda K. 💗