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Thread: Diarrhea in Nepal

  1. #11
    Join Date
    Jul 2004
    Location
    Pokhara, Nepal
    Posts
    308

    Post Re: Diarrhea in Nepal

    Everything you want to know is here: http://ciwec-clinic.com/articles/und...g_diarrhea.php

  2. #12
    Join Date
    Sep 2006
    Location
    Tokyo
    Posts
    380

    Default Re: Diarrhea in Nepal

    I used phlagyl when I had a big problem. I couldnt eat at all for 3 days except lick a little chocolate. I lost tons of weight but I did keep using the drug for the right amount of days. It took over a week before I was stable enough to travel. So with most people having limited time I can understand grabbing cipro or similar. You want it to stop so at least you can move. I lost tons of weight mostly water I guess and then rebuilt using curd. M was very useful for keeping me in a good mood as when you get these problems depression comes with it. You fear you will not get better and it will drag on and on.
    Years ago it was common to meet travellers who had hep and they were knocked off their feet and had to deal with local hospitals etc.
    I had amoebic dysentery 3 times.

  3. #13
    Join Date
    Oct 2005
    Location
    British Columbia, Canada
    Posts
    402

    Default Re: Diarrhea in Nepal

    Quote Originally Posted by odd man out
    previously: "We always carry cipro* ... have found it works incredibly fast (usually we can stop taking tabs within 24 hrs).... in Thailand, there appears to be some resistance to Cipro..."

    Taking antibiotics for a short period is what causes the spread of resistant bacteria. I question the wisdom of this kind of misuse/abuse of medications. Cipro is a very powerful topoisomerase inhibitor (as are chemotherapy drugs). Just because it is available over the counter in Nepal, doesn't make it wise or safe to use like aspirin.

    I have to disagree with both odd man out and yak: a SHORT course of cipro IS normally recommended rather than a longer course (and indeed only a short course is normally required).

    Unfortunately (and oddly), the CIWEC clinic no longer provides much info on this topic that would be helpful for a trekker who will be far from the Kathmandu clinic (such as Sama Gaon, on the Manaslu circuit). (CIWEC used to be a leader on this, but they seemed to have become a clinic simply seeing patients rather than one also doing research. But I hope I am wrong on this latter point.)

    The 2001 Public Health Agency of Canada STATEMENT ON TRAVELLERS' DIARRHEA provides much more detailed and helpful information:
    http://www.phac-aspc.gc.ca/publicat/...7sup/acs3.html

    The USA Centers for Disease Control "Yellow Book" (2010) also have a very good site on this:
    http://wwwnc.cdc.gov/travel/yellowbo...-diarrhea.aspx

    The CDC (2010) recommends the following:
    Single-dose or 1-day therapy for TD with a fluoroquinolone [e.g., cipro] is well established, both by clinical trials and clinical experience.


    [As for the action of cipro, I am no pharmacologist, but I believe cipro is a different kind of topoisomerase inhibitor (i.e., works in a different fashion/mechanism) than "chemotherapy" drugs.]

    Each to their own, but I've seen too many suffer for days (even > 1week) essentially ruining their trek or at least putting a real damper on it -- with cipro one is usually up-and-running in <24 hrs (I find <8hrs).

    Such a lovely topic!
    Last edited by Landfall38; 28th October 2009 at 09:05 PM.

  4. #14
    Join Date
    Oct 2005
    Location
    British Columbia, Canada
    Posts
    402

    Default Re: Diarrhea in Nepal

    And here's more:

    From Dr. David Shlim (former Medical Director of CIWEC), writing for US CDC on travel medicine issues specific to Nepal:
    http://wwwnc.cdc.gov/travel/yellowbo...r-3/nepal.aspx

    Empiric Medications


    Since many tourists are heading to remote areas that do not have medical care available, they should be provided with medications for self-treatment. Travelers’ diarrhea is a significant risk, and the risk in the spring trekking season (March to May) is double that in the fall trekking season (October and November). All trekkers should have an antibiotic such as ciprofloxacin for empiric treatment of bacterial diarrhea. Campylobacter accounts for as much as 20% of the etiology of bacterial diarrhea in Nepal, and up to 70% of the Campylobacter isolates are resistant to fluoroquinolones. Although ciprofloxacin remains an excellent choice for empiric treatment of bacterial diarrhea, azithromycin is an excellent alternative and should be used if there is no response to ciprofloxacin.

    Viral upper respiratory infections (URI) are extremely common, and the percentage of these that lead to bacterial sinusitis or bronchitis is high. Trekkers may wish to carry an antibiotic, such as azithromycin, for empiric treatment of a prolonged URI that results in bronchitis or sinusitis. It is possible that more treks have been ruined by respiratory infection than by gastrointestinal illness.



    So, I go with (i) experience and (ii) the experts ... both say to carry antibiotics (I carry cipro and azithro) for TD (plus for other problems).
    Last edited by Landfall38; 28th October 2009 at 12:39 PM.

  5. #15
    Join Date
    Jul 2004
    Location
    Sydney
    Posts
    2,851

    Default Re: Diarrhea in Nepal

    I carry cypro too. As well as: imodium, maxalon, condeine phosphate (mmm...), diamox; aphetamines. And this is just the legal stuff.
    yakshaver

  6. #16
    Join Date
    Oct 2005
    Location
    British Columbia, Canada
    Posts
    402

    Default Re: Diarrhea in Nepal

    Quote Originally Posted by yakshaver
    condeine phosphate (mmm...).
    Is this a codeine-impregnated condom? mmmm....

  7. #17
    Join Date
    Jul 2004
    Location
    Sydney
    Posts
    2,851

    Default Re: Diarrhea in Nepal

    Quote Originally Posted by Landfall38
    Is this a codeine-impregnated condom? mmmm....
    Now that's a creative idea!!!
    yakshaver

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