Die microbe die!

Whether travelers know it or not they’re engaged and actively participating in what amounts to a perpetual state of warfare, and this state goes above and beyond the individuals that travel to places that are actually experiencing war civil or not, or those that flirt with their own special insurgency, or view martial law as giving the people a special surprise government sponsored weekend where only law applies.
Why are you doing this to us Steve? It’s what you’re thinking right? Am I right? The simple fact is it isn’t just travelers who’ve been conscripted into this struggle (Not a Jihad I’m pretty sure: My own unique hypothesis). The entire human race over the eons has been truly victorious in battle against this massive combatant, and in turn the microbes that want to do us harm and make us pay for our transgression against nature have brought upon mankind great suffering partnered together with horrifying losses of life of unimaginable magnitude and frequently our nemesis emerges victorious. Much of these battles and the warfare are waged on the most microscopic of levels or in the most sterile of laboratories, and the major combatants be they viruses, bacteria or one celled organisms, are out to make our lives unpleasant, and miserable even.
The grim reality is that if they had their way they’d like to have a go at each and every one of us, and the fact is, at some point or another in each of our lives they probably have ruined more than one of our limited days on planet Earth.
When one actually takes the time to consider this concept it shouldn’t seem so strange to view the strategies, and counter measures that humans and microbes are constantly exchanging between each other, sometimes on an evolutionary scale to get the upper hand. Whether it’s SARS, drug resistant varieties of tuberculosis, MERSA, H1N1, (Swine flu, Novel seasonal influenza) seasonal influenza, new mutations of Malaria or some previously unknown version of hemorrhagic fever the adversaries are numerous and diverse in their approach and methodology. What I feel is perversely interesting is that it does the very same malevolent organisms a disservice to wipe out the hosts (us!) they choose to occupy because then they put themselves at a reproductive disadvantage in terms of propagation and continuity, so instead mutation is a more effective strategy. Humans counter with inoculation and vaccination, medication and advances in the form of concentrating on sanitation and hygiene methods and ways to identify and isolate vectors of transmission.
The bugs use evolution and our bodies as their laboratory; we humans use science, medicine and common sense to try and keep a step ahead or at the very least head to head with them.
Traveler’s diarrhea is an extremely common and widespread affliction which has invariable affected onwards of up to 40% of all visitors to tropical developing countries and regions of the planet and it is not to be taken lightly. Even though most people will regale their acquaintances with stories of inconvenience and abnormal manifestations of bodily functions that turn everyday activities into nightmarish scenarios filled with bodily fluids and waste products the end results can eventually impact the future everyday life if the proper treatment isn’t given to an individual in a timely and correct manner. A worst case outcome (apart from death) is Irritable bowel syndrome which can last for years and even decades as a cumulative result of multiple cases or a severe case of this all too common affliction.
As it stands now the medical community’s primary and most effective front apart from practicing good sanitary personal hygiene and preventative common sense measures (i.e. watching what and how an individual ingests food stuffs and hydration mediums) is through drugs and medications, the most common of which tend to be antibiotics because the reality of the matter is 80% of TD is caused by bacteria the other cases of course are due to viruses, one celled organisms or maladies to other internal organs.

Of course this can all be a rather controversial subject one usually debated rather than discussed. For this article I’m going to circumvent that whole realm and just discuss the latest offerings that science has developed for us a few extra arrows in the quiver so to speak.

Ciproflaxin or Cipro as its most commonly referred to has been the standard bearer for some time now and my personal drug of choice while on the road. While it’s readily available and has in some respects been around longer than many medicines apart from perhaps Deoxycyclene (its pros cons are well established) it too has as a downside, plus its misuse and over usage has now created some strains of bugs that are resistant to it. The other downside by modern standards is that the full course of treatment administered correctly is a total of 3 days. I’ve been extremely fortunate as to not encounter any of these downsides as of yet (I’ve actually given out more Cipro than I’ve ever taken myself) but the odds are stacked against us, whether it’s a medication’s side effects, or getting sick with TD or another type of gut bug I’d still rather have the medications handy than not have them available..

Fortunately the medical and pharmaceutical communities have decided that due to things like resistant strains to one drug or the other or side effects of taking certain drugs prophylacticly for moderate lengths of time that it’s best not to just leave well enough alone and to continue work on more effective faster acting and shorter duration times for dosages One of the worst forms of antibiotic misuse is stopping the treatment before it’s complete, i.e. the patient stops dosage when they feel better not when the microbe is actually completely eradicated within them.

The most recent and promising drug to come along is Prulifloxacin. It’s what is referred to as a fluoroquinolone. Throughout a series of fairly timely studies and trials this medication has been found to be very effective in treating a wide range of bugs that affect the gut of the majority of healthy individuals. It’s also been found to cut the treatment time it takes using Cipro by up to 2/3 (for slower folk like myself, that would be a single day of dosage!) with an average resolution of symptoms and infection of 3 days as opposed to 5-7 days with Cipro.

With regards to viral induced TD,
many viruses cause diarrhea, including rotavirus, Norwalk virus, (most recently these have gained wide scale public notice by affecting scads of people on cruise ships) cytomegalovirus, herpes simplex virus, and viral hepatitis. Obviously antibiotics will have no effect on these so a correct diagnosis needs to be made, which can be difficult on the road. Not a whole lot is new on this end so consult a physician about what to carry with you in the way of generalized antiviral medication. In much of the literature I’ve perused it seems as though with regards to viral infection TD isn’t a great concern except for the 20% of you that will come down with this. In the way of perspective though, compared to HIV/AIDS and Hepatitis you’ll be lucky if TD is the worst virally originating malignancy you come down with.
Fortunately science is on us the traveler’s side. In this scenario and with a new drug like Prulifloxacin to now add to the kit is looks as if even if we lapse and let down our guard for a moment or throw caution to the wind, we shouldn’t have to suffer too needlessly long armed with such an accelerated course of treatment.
For myself the unfortunate irony as a Yank, I’ll actually have to travel somewhere else that makes Prulifloxacin available to me since the FDA here in the States has not approved it for use yet…or anytime soon in fact. So it’s off to Canada or Mexico I go, neither of which place I’ll wager will really warrant having it in my kit in lieu of the Cipro that’s already there.
If I do get a hold of some I’ll keep that for myself and continue as I always have and give the Cipro out to others that usually need it more than I do.



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