Antibiotics can be your best friend, especially when infection or traveler's diarrhea strikes in the middle of a glorious vacation.
It's crucial to know which antibiotics are worth toting, how they can ease symptoms of illness and when it's wise to pop a pill. In some cases, it might even be before symptoms appear.
Infectious illnesses are common in travelers but account for only 1 percent to 3 percent of deaths, says Dr. Jay Keystone, a travel medicine specialist at the University of Toronto and Toronto General Hospital in Canada who published a review of antibiotics for travelers in the February issue of the journal Current Infectious Disease Reports.
Up to 75 percent of travelers to developing countries become ill during or after travel, he says. Infections of the gastrointestinal tract, respiratory system and skin are among the most commonly reported problems, he says.
Taking the right antibiotic and using it correctly can make the difference.
"The biggest mistake that doctors make is in not providing travelers with an antibiotic like levofloxacin (brand name Levaquin) or ciprofloxacin (brand name Cipro) to carry with them for self-treatment of traveler's diarrhea," Keystone says.
Some doctors, however, are reluctant to prescribe antibiotics, fearing patients will overuse them and later develop resistance to a drug.
In Thailand, ciprofloxacin and levofloxacin are often ineffective because of drug resistance, Keystone says, and azithromycin (brand name Zithromax) is a better choice for traveler's diarrhea.
As good as antibiotics can be in fighting bacterial infections, they are ineffective in fighting viruses.
Like all drugs, antibiotics also can have side effects, which include nausea, vomiting and abdominal discomfort.
For adults suffering from traveler's diarrhea, Keystone recommends 500 milligrams a day of ciprofloxacin and levofloxacin for three days.
Travelers, however, should consult their physician for specific medication and dosage recommendations and tell their doctor what other medicines they are taking.
Keystone says the biggest mistake travelers make is waiting too long to begin treatment.
"Travelers most often fail to take the antibiotics . . . they are carrying for self-treatment," he says. "You don't have to be deathly ill to use them." He also says that when he has gastrointestinal problems abroad, he immediately takes the anti-diarrheal Imodium as well as an antibiotic.
Dr. Stuart Rose, a travel medicine specialist in Northampton, Mass., agrees.
"At the first sign of traveler's diarrhea, take the antibiotic you have been prescribed plus Imodium, available over the counter," he says. "Take that immediately and that may be all you need to do."
If you've eaten out and worry about the quality of the food, consider what Keystone calls the "dinner-after pill" -- a single dose of an antibiotic for treatment of gastrointestinal problems. He rarely recommends the preventive use of antibiotics, though.
When he does, it's usually only for travelers with serious, chronic conditions such as diabetes or for the person who "gets diarrhea just looking at the travel poster" and is going on a trip of less than four weeks.
Packing medicines is better than buying them overseas, especially in developing countries, experts say. "Several recent studies show that there is a significant problem with counterfeit drugs," Keystone says, adding that pills sometimes contain little or none of the active drug.