Same disclosure as usual, don’t practice medicine without a license, don’t tell your doctor what to do… just kidding. I’m sure he would benefit from your interest in travel care described below.
The following are the things I consider when a patient requests for a travel kit.
Typhus and Malaria Travel Prevention
If the area is endemic for typhus as is the case for many overpopulated Third World countries, I would empirically treat with doxycycline hyclate 100 mg twice a day starting a week before departure, wrapping up a week after arrival back in the states. Not to make light of any antibiotic, doxycycline is not an exciting medication if you are a teenager or older and your bones are fully developed. Certainly it should be avoided in all pregnant women. But no more than a 1 to 2 month course as I have described above is the equivalent of a teenagers regimen for acne. Yes, that’s how safe it is.
Nicely, doxycycline also covers you for malaria. It’s especially useful right now because there are resistant forms of malaria which, as you guessed it, are fully covered by doxycycline. Dr. Dave would not steer you wrong.
So that covers typhus and malaria. And you should also contact the embassy or consulate of the country you are visiting. Find out what is endemic in case your doctor needs to cover you for anything else.
Travel Medications for Infections You May Develop Along the Way
The rest of this discussion is focused on infections and healthcare maladies you could develop along the way in countries that are not even risky for things like typhus and malaria, but rather as a result of travel mishaps.
It’s nice to have a stash of Cipro with you in case you get travelers diarrhea or for a urinary tract infection.
It’s nice to have some first generation cephalosporin with you in case you get an skin infection. There’s a one hour seminar on this that they teach us in med school, and the antibiotic that comes up for every indication is, again and again, Keflex 500 mg, twice a day for at least a week. If you are diabetic, you need that medication four times a day if there is truly a skin infection.
It’s also nice to have a supply of Zithromax 500 mg. You get good coverage for atypicals that cause bronchitis and respiratory infections and pharyngitis. These organisms are chlamydophila and mycoplasma for the most part. If you take one of these daily for three days, it fully covers those. That kind of a regimen also covers leprosy, incidentally. You probably won’t be encountering that anywhere in the world anymore. But that three day regimen does not cover A, beta strep, your old friend strep throat. That is not as prominent outside of places like the US and England, but it’s worth covering. I like to use zithromax 500 mg daily for seven days to get full strep coverage.
And it’s nice to have a Medrol dose pack with you in case you mount an allergic reaction to anything land or sea-based. 21 of the 4 mg prednisone is dosed six on day one, five on day two, and so forth. If you have to use a medication like this, make sure you have a doctor involved in the actual administration if you possibly can.
And you should have an EpiPen with you in case you are allergic to insects that are flying about where you might be. I believe there’s a national shortage, but do your best to get one if you absolutely need one.
There’s many more things you could bring. But the average healthy person should benefit from just the above.
