ladyrep

My doctor was able to connect me with a company in Canada for this medicine. I needed a prescription which he sent to the Canadian Pharmacy. I believe this meds are actually coming from India, but you cannot get it there without a MD writing a prescription. I do not want to be more specific but if you want more info you can e-mail me at [email protected].

We were given 100 pills which is enough for all four of us I believe. Those of you who have taken this medicine, did you start it before you left home, start it when you arrived, waited to see if you got sick? Our dosage is 550mg, and how many times a day. I am sure it will come with some directions, but I rely on this forum.

Thanks, the traveling four women

Jeff_Costa_Rica

I'd be concerned about what I was getting here. Will you get the brand Xifaxan or a generic product? I bet it will be a generic, which has not been approved for sale in the U.S. or Canada.

Rifaximin works by staying in the GI tract and not being absorbed, or being absorbed very minimally into your body. It fights the bacteria at the site, in other words. From what I read, the problem with the generic products that come from other countries is that some are absorbed into the body in significant amounts. The quality control is lacking in some of them.

Les

This med is expensive in the U.S., so we opted for something else on our recent trip. Now I see the ads for Xifaxan on TV, and the list of possible side effects is scary, so I'm glad I didn't get it.

I spoke with someone who lived in India for 3 months, and she recommended Acidophilus (available without Rx). She used it, and said she never got sick while she was there. The downside is that it's supposed to be refrigerated after opening, tough to do while you're traveling.

We ultimately opted for Pepto Bismal tablets (also recommended by my doctor). It apparently worked on the trip to India (we never got sick), and I've used it on other trips without incident.

julies

We've taken two 6 week trips to India, and one 6 week trip that was three weeks in India followed by three weeks in Nepal. So, in the four months we have now spent in India we never took anything like this prescription, and we lived.

Our travel clinic prescribed an antibiotic we could have on hand for use if we had travelers' diarrhea. During each six week trip we each ended up taking one round of it. However, we also had immodium (something you really don't want to use very often because it just plugs rather than cures) and Pepto Bismol.

I might also be leery of the authenticity of a medicine that may be coming from India. We are in SEA Asia right now and were at our travel clinic only a week ago. We were told that even as far as over the counter stuff we should bring what we might need or want from home since there is no way of knowing what is coming from China.

scdreamer

Les - I am curious about using the Pepto Bismol tablets. Did you take it proactively or only at the first sign of digestive symptoms (nausea, pain, diarrhea)? Any dosage suggestions/info?

Also - what about acidophilus tablets that don't need refrigeration? Are they also effective as a preventative?

scdreamer

This (below) is from the cdc - 2016 publication. They do recommend the ingredient in Pepto, as well as the possibility of probiotics having some potential positive effects.

"At this time, prophylactic antibiotics should not be recommended for most travelers. Prophylactic antibiotics afford no protection against nonbacterial pathogens and can remove normally protective microflora from the bowel, which could make a traveler more susceptible to infection with resistant bacterial pathogens. A traveler relying on prophylactic antibiotics will need to carry an alternative antibiotic to use in case diarrhea develops despite prophylaxis. Additionally, the use of antibiotics may be associated with allergic or adverse reactions in a certain percentage of travelers and may potentially contribute to drug resistance. The use of prophylactic antibiotics should be weighed against the result of using prompt, early self-treatment with antibiotics when TD occurs, which can limit the duration of illness to 6–24 hours in most cases. Prophylactic antibiotics may be considered for short-term travelers who are high-risk hosts (such as those who are immunosuppressed) or who are taking critical trips (such as engaging in a sporting event) during which even a short bout of diarrhea could affect the trip."

thursdaysd

Like julies I have traveled extensively in India without taking anything on a daily basis. The first trip was for ten weeks. I got sick once because, in order to be polite, I drank some pineapple juice which I knew to be dicey, otherwise I did not get sick. The second, six week trip, I got sick once, eating at the most expensive hotel of the whole trip. In both cases the antibiotic that had been prescribed and bought in the US dealt with the problem. I did not get sick in Nepal or Sri Lanka.

I prefer not to take medication unless I am actually sick, although I do take Malarone in malarial areas. I do travel with immodium in case I get diarrhea on a travel day, but have rarely used it.

Kathie

I'd recommend that you get on the cdc site www.cdc.gov/travel and read the whole set of recommendations.

filmwill

Medical advice is best received from a doctor and not well-intentioned strangers on a travel forum. Honest and best advice I can give.

Jeff_Costa_Rica

To clarify something here, when you get generic prescriptions dispensed at your pharmacy in the U.S., some of them could be manufactured in India. The company Teva Pharmaceuticals, headquartered in Israel, has a plant in India that makes some of its generic products. The manufacturing standards have been evaluated and approved by our FDA for import and use.

The problem is Internet pharmacies in Canada and where they are getting their drugs. It may be India, but I'm sure the manufacturer has not been approved. Generic Rifaximin from India has specifically been identified as having problems.

scdreamer

thursdaysd & julies : Not wishing to muddy the waters, but I am curious about the U.S. prescribed antibiotic you brought along for use in the event of illness.

Have not been to India, but have traveled extensively in South America and Central America - my husband always brings with him Cipro, and has used it twice to circumvent severe and sudden food-borne illness.

For our upcoming month in India, however, we have been told that Cipro is not effective, as it has been overused to the point that the local bacteria that causes gastrointestinal illness is no longer affected by it.

Has that been your experience?

thursdaysd

Yes, the first trip (2001) I was prescribed Cipro. The second trip (2010) it was something else I have forgotten. I noticed in 2001 that you could buy Cipro in India very cheaply and without a prescription, no doubt that is why it is no longer effective.

As kathie says, the CDC site has lots of useful info. I generally don't use my GP for travel medicine. I used to use the Duke Travel Clinic, but last time I needed something travel-related I used Passport Travel, which seems to have a lot of branches.

Kathie

Note that Cipro is no longer very effective in SE Asia, India and Nepal. The currently recommended antibiotic to take along (Not to take as a preventative) is azithromycin). I always take some long, have rarely had to use it, fortunately.

crosscheck is the person here who posted about Rifaximin. She has several posts about it, you might want to do a search.

There has been research done at Bastyr here in Seattle about the usefulness of acidophilus in travel. They found that acidophilus didn't prevent GI problems, but it did mean that the person taking it recovered faster.

And yes, you should consult with your own physician or a travel medicine professional.

Ladyrep, the fact that your doctor referred you to this particular pharmacy in Canada would help me feel confident about the quality of their products. I do know that there are plenty of reputable Canadian pharmacies that sell by mail.

Les

scdreamer, I took one Pepto tablet daily, my wife took two daily. Her doctor said there was no problem taking up to four tablets daily, but we never needed that much. It's basically proactive, and seems to work.

As for the Acidophilis, the bottle we got (at Vitamin Cottage) says to refrigerate after opening, because it contains live bacteria culture (similar to the Typhoid 4-pill vaccination we took). I don't know if there's a brand that doesn't need refrigeration. And yes, they're a natural supplement that can be taken daily.

julies

We are lucky that we live in a large metropolitan area so have access to an international travel clinic, so they are very familiar with all of these issues. They gave us azithromycin as an antibiotic to take if necessary.

lcuy

You can get probiotics (acidophilis) in granular form. They are in little foil sachets, so they keep fresh unrefrigerated. I buy the brand Hexbio in Asia from a very reputable pharmacy, but I know they have other brands in the US.

I notice a difference in how my digestive system works when I am taking them on a regular basis, but that's just me.

FromDC

DH and I both took rifamaxin last year during our trip to India. I had no stomach issues, DH was sick the very first day we got there when he began taking the pills, not sure whether it was related to taking the medicine or not. He was fine after that for the next 2 weeks, continuing to take the pills throughout the trip.

ladyrep

Controversial subject, Dr. said to take if we get sick but i would rather not wait. Any downside of taking the whole time?

Kathie

Rifamaxin is meant to be taken as a preventative. If you only want something to take once you get sick, opt for azythromycin - cheap and effective.

scdreamer

How about getting Azythromycin or Rifamaxin OTC while in India if need be?

My husband went to the doctor two days ago to see about a Z-Pac to take with us, and the doc said he would only prescribe Cipro - and was reluctant to even do that. Did not seem to believe us that it is not the drug of choice where we are going.

Long story short - our trusted family doctor of 34 years died unexpectedly of an aneurysm earlier this month - he knew us well and was always great about prescribing antibiotics for travel. Now we are scrambling to find new doctors - and leaving for India in less than a week!

We will take Pepto Bismol daily as a preventative, but wondering about getting appropriate antibiotics OTC if needed.