The Best Traveler’s Diarrhea Drug

American pharmaceutical companies often charge exorbitant amounts for drugs, and when the writer of our Cozumel piece, a physician, said he used Rifaximin, an antibiotic, to treat of travelers' gastroenteritis, a subscriber, Bob Halem (San Jose, CA), investigated the advice. The best price he could find for 42 tablets was a whopping $1500, a larcenous amount. So, we queried our writer and this is what he replied:

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Diarrhea is an occupational hazard for all international dive travelers. While typical of Mexican travel, it can affect divers traveling in the Caribbean, Red Sea, Indonesia, Micronesia or anywhere.

It's caused by consuming food that contains bacteria your gastrointestinal system is not used to. All food, especially uncooked food, vegetables, and water, contain some bacteria. If we are not used to those found in foreign lands, they can raise hell with our G.I. tracts until we get accustomed to that strain of bug.

Typically, these are various strains of E. coli that local residents are used to, but not us travelers. We think of them as "bad bacteria" or "food poisoning," but they are not bad, it's just that we aren't used to them. After we have been exposed to these bugs for a while, we become "immune" and have no more trouble.

For example, most of us who have been to Mexico a few times and had "tourista" can now eat any reasonable food there without a problem. However, for traveling divers who haven't been exposed, this can really become a problem when they get hit with a severe case of diarrhea that can ruin the whole trip. How to prevent this?

We have all been told "don't drink the water" in foreign countries, and there's good reason. Even potable (safe to drink) water in most countries has a low level of the bacteria that will cause newcomers to get gastroenteritis. Not drinking the local water is inconvenient, sometimes impossible, and although it may help prevent traveler's diarrhea, it's no guarantee. The offending bacteria are everywhere and impossible to avoid. The best way to prevent the symptoms is by taking antibiotics, either starting before arriving or taking them immediately at the first sign of Montezuma's Revenge.

In the past, antibiotics such as Bactrim were used (and still can be used), but it has a high enough incidence of allergic reactions to make it less than optimal; Bactrim is actually absorbed into your system, and that can lead to problems. Now, there are protocols and antibiotics specifically for preventing of traveler's diarrhea that are far better and affect only the G.I. system as they are not absorbed.

The current treatment of choice is Rifaximin (Rifamixin and Xifaxin are other names). It is an antibiotic that is NOT absorbed into the body after being swallowed, but just passes through the G.I. tract hence far lower likelihood of allergic reactions. It stops traveler's diarrhea quickly when taken at the first hint of symptoms. On a recent dive trip to Mexico with over 30 people (of whom about half developed symptoms of Montezuma's revenge), it halted symptoms in about four hours when two 200 mg tablets were taken at the first sign of problems. This saved a lot of dives! It was then followed by taking one 200 mg tablet twice a day for the rest of the trip.

The only real problem is the cost in a U.S. pharmacy: can be up to $30 or more a pill! Most insurance companies will pay for it, but the cost is ridiculously variable.

In Canada, it's a small fraction of the cost, and therefore, I buy mine online from Canada and receive it by mail. A hundred 200 MG tablets from a reputable Canadian pharmacy, Blue Sky Drugs, is currently $79. They add about $20 for shipping.

Besides Blue Sky, there are scores of reputable mail order online pharmacies in Canada that sell medications to the USA. They require a subscription from your doctor that conforms to U.S. importation regulations. Their medications are just as good as those made in the USA and frequently may even be in the same foil blister packs from the same USA pharmaceutical companies, for pennies on the USA dollar. You can be assured that they are regulated by both the Canadian pharmaceutical industry and, to some extent, U.S. law.

Blue Sky pharmacy in Vancouver, BC (www.blueskydrugs.com) prefers to have direct access to a bank account -- perhaps just as you may pay other bills -- which stops any transfer charges. Since it's an unusual arrangement, I opened a new account just for them and when I order something, I put the necessary money into the account. Other Canadian pharmacies accept credit cards.

I am not advertising for Canadian pharmacies. But for traveling divers, Rifaximin 200 mg can be a trip saver. And, if you don't have insurance to cover U.S. prices, they are a very good option.

- D.D.