The short version:
A few days ago we we got home after six weeks of traveling extensively through both Southern and Northern India.
The two of us had an wonderful trip. And during that time, we ate whatever we wanted, including many foods commonly on "avoid" lists. And we had virtually no digestive problems. Every morning we both took low-dose generic Xifaxan which we purchased cheaply in India.
First some caveats:
I have no medical background. I'm just reporting on the experience of my wife and myself during 6 weeks in India. Obviously I can't promise anyone else our experience And everyone should consult a good doctor before considering such a regimen and consider seeing a travel/tropical diseases doctor before traveling to a place like India.And just to be clear, I have no relationship whatsoever with any drug company or seller of this drug.
The longer version:
Like many people, I was concerned about our coming down with any of the stomach problems so commonly experienced by travelers to India. Particularly as our long trip time increased the odds we would. And we had some lengthy drives planned through regions where toilets were going to be scarce. Not to mention the potential for time lost and the discomfort. So I was intrigued by what I'd read about Xifaxan as a possible way to avoid these problems.
We see a doctor who is a tropical disease specialist before some of our trips. He's at a well-respected hospital in New York City and has had a number of papers published. So I turned to him for a medical opinion about using Xifaxan as a prophylactic to avoid stomach problems while in India. He knew all about it, but said he wanted to check the latest studies, and he'd get back to me. A few days later he called me back (amazing, a doctor who calls you!) He told me that the latest studies showed we could safely take it for an extended period, and that there is no need to use the commonly prescribed 400mg, as 200mg seems to work as well, which would save us a lot of money.
Which brings up a major issue - price. Xifaxan is insanely expensive in the US, and neither of our health insurance would cover it for the use we planned. And although I'd seen it available inexpensively for sale on overseas websites, I think that buying any drug on the internet would be just asking for trouble.
So I asked our doctor about buying a generic version while in India. I was hesitant about going that route, as I've read mixed reviews of the quality and efficacy of generic drugs from some parts of the world. But he said that if we stuck to well-established Indian pharmaceutical companies, that the quality would be good. He suggested buying 6 tablets here in the US (3 for each of us), so that we'd be covered for our first three days of our trip, and then use a second prescription to get the rest in India. We'd be spending our first 3 days in Kochi, which has good health care, so that seemed like a good plan.
He also advised that even with the Xifaxan we should follow the usual advice of avoiding uncooked fruit and vegetables, etc. But based on all that we had read, we decided to eat what we wanted, within limits.
So the day we arrived, we gave our prescription to a pharmacy in Kochi associated with a well-regarded hospital, and purchased 100 pills. All were individually wrapped in foil strips with an expiration date of late 2017. The one we bought has the not terribly lovely brand name of Rifagut.
As for price, the 6 pills purchased an a CVS pharmacy cost me $105.00. Thats's $17.50 per pill!
The 100 pills purchased in Kochi cost $18.00. That's 18 cents per pill!
If we'd bought the entire prescription in the US, it would have cost us $1800.00! Completely unaffordable.
So we were able to enjoy salads, fresh fruit, raw herbs sprinkled on our food, street food from stalls that looked relatively hygienic and busy, etc.
We're not completely crazy, so we did try to avoid the most dangerous practices. It was obvious that we needed to avoid tap water, and used bottled water to brush our teeth. But I'm sure we accidently ingested some anyway from time to time. For example, in one very good Thali joint in Madurai, I watched with trepidation as the waiter poured tap water on the banana leaf that was to be our plate, and then wiped it across the leaf with his bare hand. He then spooned our food onto the still damp leaf.
We both did have a couple of incidents of extremely mild stomach discomfort, but never anything more, and these only lasted a few minutes. And this was the only problem during 6 weeks of enjoying great Indian food! So after such great results, we've decided we'll be using it again on an upcoming trip to SE Asia.
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Our India trip: 6 weeks of raw fruit, salads, vegetables & street food!
The short version: