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Scot: Dr. Miller, you told me that one of the questions you get around this time of the year is people wanting to get an antibiotic because they are going to be doing some traveling and they are afraid that they are going to go to some country and then get a bug that's going to cause diarrhea. Is that something that you can even do?
Dr. Miller: I get that question quite frequently. People will come in and they'll say, "I'm going on a trip and I just want to make sure that when I go to this new country, I might get diarrhea. Should I start an antibiotic to prevent getting diarrhea?"
Scot: They want to do something to prevent it?
Dr. Miller: They do, and the reality is taking antibiotics can cause far worse side effects than you might even ever get from traveler's diarrhea.
Scot: I think that's hard for people to understand because it's like . . .
Dr. Miller: Well, we've got into the notion that antibiotics, there's no downside to taking them, that there's no side effects from antibiotics. That's just simply not true. The issue is using an antibiotic when you need it, not as a prophylaxis or preventative, especially when you're going traveling.
Scot: Some of those downsides from what I understand is it can mess up your gut flora and fauna in some instances.
Dr. Miller: Yeah, one of most common things we're dealing with now is C. difficile colitis, which is an awful antibiotic induced diarrhea that is very, very difficult to treat.
Scot: Wouldn't that be ironic? They want to take it to prevent diarrhea . . .
Dr. Miller: Sometimes when they take antibiotics, they actually come back with the C. difficile colitis and it's not traveler's diarrhea. They've self-induced the problem and so after diagnostics, you figure out, "Oh, my gosh. This was induced by the antibiotic that they took to prevent traveler's diarrhea," not a good situation.
Scot:Taking it before, not a good idea. What about having it with you, when you do travel, if you do get something?
Dr. Miller: Right, so that's another issue entirely. It depends on where you're going. If you're going to a third world country and you're going to be out of major urban areas and in the rural areas, probably having antibiotics prescribed by a physician that you can keep with you and understand that when you develop symptoms consistent with traveler's diarrhea, you begin to take those antibiotics. That does make sense. However, people will also request antibiotics when going to other first world countries. That's probably not necessary, unless you're in certain situations where water is unclean, but most major cities of Europe and Asia have clean water supplies and it's not an issue. Also tourists are also in the habit of buying bottled water now.
Scot: I'd heard that . . . I went to Cancun one time and I was under the impression that I should not drink the tap water there, to drink bottled water there. How would I know if where I'm going is some place that's safe or not?
Dr. Miller: That's a really good question. One of the things people can do is get on to the CDC website for travelers and look up the information about particular countries. In addition, we have a travelers clinic here at the University of Utah that can advise people on what are the correct situations under which you might want to begin taking antibiotics if you develop certain symptoms, and also in which countries you'd want to be concerned about the safety of the water supply.
Scot: It sounds like bottom line, taking antibiotics as a precautionary measure - bad idea, could actually cause worse problems, anything that it prevents.
Dr. Miller: No question about that. Yeah, absolutely. There are some things that people can do also to cut back on the risk of developing antibiotic or excuse me traveler's diarrhea, which is caused by certain strands of bacteria. Those would be making sure that the food you eat is cooked, not eating raw vegetables in areas where the water supply in question. If you're in rural areas and have the ability to purify water, you can bring now very simple water purification kits and you can use those, they're very effective. I've been camping in the back country for years and years and years and never have had a problem when I use water purification tools.
Scot: You can take those with the iodine tablets if you really need to use any of that kind of stuff?
Dr. Miller: Iodine tablets, if used correctly, you can take purification filters. They're now very small and pack easily in a backpack or a suitcase. Again, it's important to know where you're going and also to be aware of the situations you're going to be in where you're eating and the environment that you're in. That is probably more important than anything.
Scot: That knowledge of knowing what's going on.
Dr. Miller: Right. So keeping the antibiotics as a backup if you need them. That's the best.
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