Stomach Blues-Dukoral??

Apr 21st, 2006, 05:11 AM
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Stomach Blues-Dukoral??

When I've travelled to Asia and Mexico for a couple of weeks at a time I usually carefully enjoy the food and then spend one weekend in the hotel room while my body does battle with what lives in the food. I normally pack something for diarrhea but this time we're travelling in SEA for 2 months. What are your opinions about health issues in taking anti-diarrhea medication such as Dukoral?
Anni_Paul is offline  
Apr 21st, 2006, 05:42 AM
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It only works against ETEC and V.cholera. There are many other things that can give you traveler's diarrhea.

The most common side effects of Dukoral are "Diarrhea, fever, feeling sick to your stomach, throwing up, and stomach pain, sore muscles, feeling tired and weak, and feeling faint"

It's expensive (unless you are in Europe)

And it's only 50% effective.

Sounds great!

I've always been a big proponent of taking massive doses of acidophulus starting about a month before the trip and then bringing immodium along just in case, but it sounds like you are pretty sensitive if you usually get sick no matter how careful you are, so maybe you should try it.
offwego is offline  
Apr 21st, 2006, 07:05 AM
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Everyone's system is different; but, throughout my two-and-a-half years in Southeast Asia (primarily Bali, Sinapore, Thailand and environs), I found the food to be constipating if anything. All that white rice with few raw vegetables! I don't know how the average Asian manages.

Like I say, only you know what your body's like. I can offer you no personal experience in terms of diarrhea. I do like offwego's suggestion about massive doses of acidophulus though. And it goes without saying that you have to avoid drinking tap water and drink instead from the best glass or plastic bottles available. That, however, is fairly true the world over at this point.

Have a safe and wonderful journey.
DrZZ is offline  
Apr 21st, 2006, 07:13 AM
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Dukoral is used as a vaccine against cholera, and it also is somewhat effective against e. coli, as offwego notes. Even against these, as she notes, it's only 50% effective. In your case, I doubt that it is either of these two "bugs" that is causing your problem. It is unclear to me whether it it "unfamilar flora and fauna" causing your probalems or whether it is simply the change in diet and spices.

You may be better off with the "Pepto-bismol cure" in which you take a preventative doses daily (but it turns your tongue black). There are people who swear by this, and there is research that backs the claim that this has some effectiveness.

I don't know what you take when you get sick, but the usual advice is to try to ride it out without medication, keeping yourself well-hydrated. If you must travel, an anti-diarrheal like immodium can be a life-saver, But if you have the option to stay at the hotel for a couple of days and get through it on your own, you are probably better off. (The theory here is that not taking the anti-diarrheal allows you to get rid of the offending bacteria, rather than retaining it and perhaps making yourself more ill.)

Antiobotics (I do always carry one just in case I get really ill, with directions for use for different kinds of infections. The only time I've ever used then was when I started getting pneumonia in Aspen, Colorado!) Don't take an antibiotic unless you must. Your doctor should give you explicit instructions about when to use an antibiotic for diarrhea.

I know offwego swears by acidophulus. I'm glad it works for her, but the research evidence finds no difference in GI upsets by taking or not taking it.
Kathie is offline  
Apr 21st, 2006, 08:22 AM
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<the research evidence finds no difference in GI upsets by taking or not taking it>

It is true that there is a lack of research. This is usually the case when there's no money to be made by some pharmaceutical company on the back end.

However, there is no denying that diarrhea can be exacerbated by an imbalance between "bad" bacteria and "good" bacteria in the intestinal tract.

I don't know why anyone wouldn't want to hedge their bets and beef up the "good" when you know you're going to get plenty of "bad". Whether this be at home or in India.

There is quite a large body of evidence that good intestinal flora boosts the immune system; also good when traveling.

I know doctors routinely give aids patients high levels of bifidobacterium to treat chronic diarrhea with good success.

And there certainly is plenty of antecdotal evidence. Enough that the Mayo clinic has recommended more research be done.

No one will make money on it, so I won't stand on one leg waiting for my doctor to tell me it works. But meanwhile, it certainly doesn't hurt anything to take it. Especially if you already think your body is "battling food". That is true feedback from your body and perfectly describes what is going on!

Anni I'll be interested to hear what you have to report if you decide to go the Dukoral route.
offwego is offline  
Apr 24th, 2006, 06:06 PM
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We had a meeting with a tropical disease specialist this afternoon and he stated that Dukoral was only 50% effective against E. coli and not at all against the various other unfriendlies (Shigella etc) - so in his estimation it was about 25% effective. We are taking a daily dose of acidophilous but would appreciate your guidance on what is a "massive" dose.
Anni_Paul is offline  
Sep 8th, 2007, 08:40 AM
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Another thread mentions that pepto-bismol caplets - with water - will prevent the "black tongue" effect.
NGail is offline  
Sep 25th, 2007, 03:40 AM
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I also went to the Travel Medicine clinic last week. The physician there stated that Dukoral is 25-30% effective and left the choice up to us. We did take the hep A and typhoid vaccines though.

We decided to take the Dukoral because of a recent experience in Egypt with traveller's diarrhea which cost my husband a full day of touring in Aswan. We don't want to miss anything!

Surprisingly, you don't need a prescription to buy Dukoral in Canada. I don't understand this as all other vaccines are tightly regulated. To me, it means that Dukoral is probably not effective. Anyway, it cost us $85 each! Very expensive but cheaper than an extra night of hotel.

Probably the best way to prevent diarrhea is to bring along hand sanitizer and use it frequently. Avoid tap water and ice and anything that may have been washed in tap water (fruits, salads). Anything hot should have had all the germs killed in it.
small_but_feisty is offline  
Sep 25th, 2007, 05:42 AM
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I'm glad someone brought up this old thread, as there has been a subsequent study on the use of acidophilus and travelers diarrhea done by Bastyr. There were two studies done, I reported on the first in my post of 4/21/06. Preventative doses of acidophilus made no difference in rates of TD in travelers.

The follow-up study looked at the use of acidophilus in treatng TD. People who took acidophilus at the first sign of TD had less severe TD and it lasted a shorter period of time than those who did not take acidophilus. So, it appears that acidophilus is a good supplement to take along on your foreign trips. If you begin to get symptoms of TD, start taking it immediately, and continue until the symptoms are gone. There are other probiotics, but acidophilus was the only one tested in this study.
Kathie is offline  
Sep 26th, 2007, 01:26 PM
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Ok here's my experience with Dukarol - Prior to taking it I had a nasty case of the trots in India. Subsequently for I think our last 5 overseas trips I have taken Dukarol with no side effects whatsoever and no stomach upsets. I take it every trip now as it is really cheap insurance. Our Travel Medicine clinic highly reccommends it and I would not travel without taking it.
galiano is offline  
Sep 26th, 2007, 01:50 PM
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Thanks for that report. Do you know if the acidophilus was the refrigerated type or is there another non-perishable type?
Tim_and_Liz is offline  
Sep 26th, 2007, 01:52 PM
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Also do you have a link to the article? I tried googling various combinations but could not find it.
Tim_and_Liz is offline  
Sep 26th, 2007, 01:59 PM
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Our Travel Clinician recommended florastor - anyone had any experience with that?
geosand is offline  
Sep 26th, 2007, 04:58 PM
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Tima and Liz, sorry, I don't have a link. I read the synopsis of the article in a local newsletter.

There are high-quality unrefrigerated acidolphus pills, go to a reputable supplements or health food store and ask for a recommendation.

geosand, I've never heard of florastor, but it sounds like a probiotic. Is that what it is?
Kathie is offline  
Sep 26th, 2007, 05:24 PM
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I have taken dukoral on several occasions...going to Bolivia/Peru, Tanzania, Thailand/Malaysia etc. It is hard to say if it worked or not but at least there was no side effect to the medicine and I have never really had any major problems with getting sick from food. One thing is for adventurous when it comes to eating local food. It is an important part of the experience when traveling

Gard - trip reports and pictures
gard is offline  
Sep 26th, 2007, 05:39 PM
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yes kathie it would be classified as a probiotic
geosand is offline  
Sep 26th, 2007, 05:42 PM
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The study reported by Bastyr used only acidophilus, not any other probiotic. I don't know of any research on other probiotics and TD.
Kathie is offline  
Sep 29th, 2007, 11:38 AM
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i carry along cipro when i travel, especially to SEA. I only use it when the TD is clearly something much more serious than an upset stomach. In Thailand I tried to "wait it out" but clearly it was something more than just TD and after one day of cipro i was so much better. Whatever the cost, i see a prescription for cipro (or similar antibiotic) as another form of travel insurance.
alison is offline  
Sep 29th, 2007, 12:36 PM
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There has been well-documented resistance to Cipro in mainland SE Asia. Cipro is fine for India, for instance, but you should carry a different antibiotic to Thailand, Laos, Cambodia, VN, Burma.
Kathie is offline  
Sep 29th, 2007, 12:49 PM
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We are going to Siem Reap and Bangkok and my travel physician prescribed Azithromycin for TD (if needed).
Tim_and_Liz is offline  

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