Help Patients Stay Healthy During Travel

Summer will bring questions about travel-related illnesses.

Traveller’s diarrhea can occur anywhere...but some of the highest-risk destinations include Mexico, the Caribbean, and South America.

Patients should take preventive measures...such as avoiding raw foods and tap water or ice, brushing teeth with bottled water, etc.

But they should also pack meds to treat diarrhea just in case.

For example, most patients should bring along OTC loperamide (Imodium) for mild diarrhea. Or bismuth subsalicylate (Pepto-Bismol) is an option...but it takes longer to work and may be less effective.

Point out warnings on package labels. For instance, loperamide may cause breathing issues in kids under age 2...and bismuth subsalicylate shouldn’t be used in pregnant patients or children.

Don’t be surprised to dispense antibiotics in some scenarios. For example, patients travelling to developing areas may get 3 days of azithromycin to have on hand if more severe diarrhea hits.

Altitude sickness can occur when going to high elevations...during mountain climbing, hiking, etc. To limit symptoms, patients should stay hydrated...limit alcohol...and ascend gradually.

Expect to see Rxs for a preventive med, usually acetazolamide, in higher-risk cases...such as travelling over 3,500 m (11,000 feet) in one day.

Ensure that patient allergy info is current when dispensing can cause problems in patients with severe sulfa allergies.

Also check that all prescriber directions are on Rx labels. Patients will generally start acetazolamide a day before ascent...and continue for 2 to 3 days after reaching the highest planned altitude.

Mosquito-borne illnesses (dengue, malaria, Zika, etc) are more common in tropical areas...and require prevention strategies, such as insect repellents (DEET, etc) and possibly vaccines (yellow fever, etc).

Anticipate filling Rx antimalarials (atovaquone/proguanil, etc) for travellers to malaria-endemic areas, such as Africa or South Asia.

Stay alert for mix-ups with these meds. For example, atovaquone/proguanil (Malarone) is taken once a DAY...but mefloquine is used once a WEEK.

Also watch quantities and days’ supplies closely. Antimalarial meds usually need to be taken before...during...and after travel.

Immunizations can prevent some travel-related illnesses...and some countries mandate certain vaccines as a requirement for entry.

Encourage patients to find out about required immunizations as soon as their travel plans are confirmed...and not wait until the last minute.

Some vaccines require multiple doses that may need to be given over a month or longer...other vaccines may need to be administered within a certain length of time, such as 10 to 14 days prior to travel.

Take our CE course, Common Travel-Related Illnesses, to learn about jet lag, motion sickness, blood clots, and more.

Key References

  • Government of Canada. About personal insect repellents. June 2, 2021. (Accessed May 27, 2024).
  • Shane AL, Mody RK, Crump JA, et al. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis. 2017 Nov 29;65(12):e45-e80.
  • Luks AM, Hackett PH. Medical Conditions and High-Altitude Travel. N Engl J Med. 2022 Jan 27;386(4):364-373.
Pharmacy Technician's Letter Canada. June 2024, No. 400610

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