Cipro dose....500/250mg

[kaneohe]

For travel to China, my doc prescribed 500mg while DW's
substitute doc prescribed 250mg. Is there a generally agreed upon standard? Is one of them incorrect?
edit to add: usual tourist places in N. China...Beijing/Shanghai/River cruise

[Rich_by_the_Bay]

Quote:

Originally Posted by kaneohe For travel to China, my doc prescribed 500mg while DW's substitute doc prescribed 250mg. Is there a generally agreed upon standard? Is one of them incorrect? edit to add: usual tourist places in N. China...Beijing/Shanghai/River cruise

What is it being prescribed for? If it's for travelers' diarrhea, the recommended dose is 500mg twice daily for a day or two (start after the sympoms first appear). Cipro reduces caffeine metabolism so avoid combining the two.

[travelover]

I carry Cipro when I travel internationally, but I don't take it unless I really feel it is serious because antibiotics tend to mess up my system. My doc recommended that I take acidophilus tablets with antibiotics and it does seem to help. YMMV

[kramer]

Yep, it is just like the doc said for traveler's diarrhea. 500 mg twice daily until symptoms disappear, but normally recommended 1-3 days. Just take two of the 250 mg pills each time

If you go to the CDC website, they have changed the recommended anti-biotic to Zithromax (Azithromycin). Apparently, a lot of bugs are resistant to Cipro now. I have used it in situations where I was really sick and it did not help at all. But then it could have been a virus.

I actually carry both of these drugs on my travels. I just buy them over the counter overseas instead of setting up an appointment with a doctor in the USA just to get what I already know about. I use them very carefully. When I was going on a 7 month trip through Southeast Asia, the USA doc only gave me a subscription for 10 Cipro tablets, which really annoyed me.

I just got the typhoid vaccine here in Colombia because my last vaccination expired. I would have done it in the USA, the vaccine is more expensive but still competitively priced there, but a doctor wanted $85 from me just to write a prescription.

Kramer

[kramer]

Quote:

Originally Posted by travelover I carry Cipro when I travel internationally, but I don't take it unless I really feel it is serious because antibiotics tend to mess up my system. My doc recommended that I take acidophilus tablets with antibiotics and it does seem to help. YMMV

My understanding is that acidophilus tablets (a probiotic containing live bacteria) build up good bacteria in your digestive system, making you more resistant to food-borne illness (in other words, you take it for a period of time prior to travel and maybe during travel). However, a big problem is that often the little critters in acidophilus have all or mostly died, according to independent tests (and apparently it is unregulated). Also, many (but not all) acidophilus tablets require refrigeration so that makes them unsuitable for travel. I figure that when I am actually traveling to a place like China, my digestive system is already getting enough new bacteria.

What many recommend to get the same effect is to eat yogurt that contains live bacteria daily for 2-3 weeks before leaving. Many people have claimed this helps, although I have not searched the literature for any info on whether or how much it really helps.

I didn't get sick in China (month long trip) despite some pretty bad conditions there but my travel partner did. A typical above average restaurant has a bathroom with squat toilets and no toilet paper and no soap. It is the latter that really worries me. A typical bus station has squat toilets with little privacy, the barriers separating squatters are maybe 30 inches tall, and you want to give the attendant exact change as you don't want them to give you change back. Carry anti-bacterial lotion. I would say China is the most unsanitary country that I have visited.

Kramer

[LOL!]

I've spent 3 weeks in Beijing and several of our employees travel their regularly. I have never heard of any us getting sick with bacterial infections and needing antibiotics. In fact, this thread is the first I've heard or read of anyone taking antibiotics with them to China. From the thread title, I was thinking you had some ideas about anthrax.

[travelover]

Quote:

Originally Posted by kramer My understanding is that acidophilus tablets (a probiotic containing live bacteria) build up good bacteria in your digestive system, making you more resistant to food-borne illness (in other words, you take it for a period of time prior to travel and maybe during travel). ...............Kramer

The way I understood it, the Cipro kills the bacteria in your gut and the acidophilus tablets or yogurt replaces them, thus minimizing the bad effects (like the runs) of the Cipro. Maybe a placebo effect, but it works for both me and my brother.

[kaneohe]

Thanks, Rich and others, for reading my mind and guessing the purpose and confirming the 500mg dose (2 tablets). Thanks, Kramer, for the new CDC
recommendation. Will have to research that. Apparently same cost for 10@500mg or 14@250mg so more bang for the buck w/500mg tho still pretty reasonable either way. Will have to make sure I study exchange rates and have exact change for attendant....what's usual charge?

[kramer]

Quote:

Originally Posted by kaneohe Thanks, Rich and others, for reading my mind and guessing the purpose and confirming the 500mg dose (2 tablets). Thanks, Kramer, for the new CDC recommendation. Will have to research that. Apparently same cost for 10@500mg or 14@250mg so more bang for the buck w/500mg tho still pretty reasonable either way. Will have to make sure I study exchange rates and have exact change for attendant....what's usual charge?

Ha, I forget exact charges, probably 1 yen. Get your prescription filled at Walmart for anti-biotics, they only charge $4 for Cipro.

Kramer

[kaneohe]

K.....thanks. Target $4 also, Costco $5.90. Now all I have to do is master the squat and I'm all set..........

[kramer]

Quote:

Originally Posted by LOL! I've spent 3 weeks in Beijing and several of our employees travel their regularly. I have never heard of any us getting sick with bacterial infections and needing antibiotics. In fact, this thread is the first I've heard or read of anyone taking antibiotics with them to China. From the thread title, I was thinking you had some ideas about anthrax.

It is normal to take a few anti-biotics with you for travel around any developing country. It could be the incidence of sickness of your employees is less than normal because they are in the rich capital of the country and eating at better places. I traveled all over south China and my friend that got sick was born and raised there.

I was actually keeping stats on my travel in developing countries, and I got sick approximately once every 3 months, this was eating basically every meal out. I can't recall getting sick in the USA off food I have eaten in my entire life (or Europe), I always said I had a steel stomach. In developing countries, the locals that live there take it as a fact of life that they often get sick from the food that they eat. Most food preparers do not wash hands with soap after using the bathroom and do not use toilet paper (even in "restaurants"), refrigeration is questionable, and there are lots of insects. Nuff said

After a few times getting sick and paying attention to what I *think* caused the problem, I changed my eating rules a little and that has helped. My rules are now no dairy products unless I am sure about their hygiene and even then I am hesitant. And no sausage. No sliced fruit stored in ice. I have not gotten sick from food I have eaten for a long time now. Plus, the standard of hygiene here in Colombia where I am presently located is more like a first world country than some of the bad conditions one sees in SE Asia. Surprisingly, I don't think I have ever gotten sick off a salad, which is what most commentaries you read warn about.

Kramer

[Janet H]

Also pack the acidophilus tablets and some folding TP. Do NOT count on finding either when when you need them.

[SecondCor521]

Hunh. I was in the business district of Shanghai for a week earlier this year and all the toilets and bathrooms I encountered were the regular Western style, with TP and regular handwashing facilities also -- soap, sinks, paper towels and/or hand driers. Didn't get sick from the food either, and it was fabulous.

However, there is a pretty wide variety of economic "strata" so I can certainly imagine that the more primitive conditions do exist there as well.

2Cor521

[kramer]

Yes, I think the business district of Shanghai or Western style hotels in Beijing are a world away from the conditions in 98% of China -- those are the 2 richest cities in China proper (not counting Hong Kong). While most (but not all) of the hotels we stayed in had Western style toilets, I can't remember actually seeing a Western style toilet outside of a hotel in my travels in China (like in restaurants, etc), although it has been 3 years and I could have forgotten. I did not visit Beijing or Shanghai, but more Chinese tourist cities like Guilin, Guangzhou, Dali, LiJiang, Kunming, Hainan island. I was more free to do this because my friend spoke both Mandarin and Cantonese fluently.

I am sure it depends a lot on where you travel in China. I learned so much about China (most of it negative) and it was a great experience. I don't think I met any Chinese person on the whole trip that spoke English, but my friend could interpret. My biggest fear before going was the food (not the cleanliness but the taste), but it turned out I loved almost everything.

At the end, when leaving China, we took an all night, bone jarring bus from Kunming to Sapa, Vietnam, probably the worst travel experience of my life. It was simply the worst travel conditions I have ever experienced even counting long bus rides in Myanmar It was the real China, with mean looking army guys at various checkpoints checking everyone's passport or identity card, etc. They are all about control of the population.

Kramer

[BigNick]

Quote:

Originally Posted by kramer Apparently, a lot of bugs are resistant to Cipro now.

Quote:

Originally Posted by kramer I have used it in situations where I was really sick and it did not help at all. But then it could have been a virus.

I suspect that these two are not entirely unrelated. There is some suggestion that people who self-medicate with antibiotics are a non-trivial cause of increased resistance.

[kramer]

Quote:

Originally Posted by BigNick I suspect that these two are not entirely unrelated. There is some suggestion that people who self-medicate with antibiotics are a non-trivial cause of increased resistance.

Yes, virtually any use of anti-biotics will help organisms develop resistance. Overuse and unnecessary use are what is bad and should be avoided. I have never overused anti-biotics, if that is what you are implying? Self-medication and overuse are not synonymous, not even close. The root problem is a doctor or patients who prescribe or take an anti-biotic as a placebo for flu, cold, etc.

I have heard of some short term traveler's pre-emptively taking anti-biotics during travel, and I think this is very bad practice. It is not recommended by the CDC.

It is hard to say what the root problem is when an anti-biotic does not help for stomach and diarrhea problems. According to a very well researched field guide I have on travel medicine, about 20% of these cases are caused by a virus. And there is not much you can do about that. According to the guide, the way to tell the difference in whether a virus or bacteria is the cause is that when you take anti-biotics and don't get better, the cause is very likely a virus.

There can also be some long term effects by letting food-borne illness rage too strongly in your body:

Long-Term Ills Tied to Bad Food - washingtonpost.com

Quote:

Pierce belongs to a small subset of people who develop long-term health problems from food poisoning. Their ranks are growing. Over the past decade, as medical experts have sought out the source of certain chronic illnesses, they have increasingly found links to episodes of food poisoning, sometimes many years beforehand, according to the Centers for Disease Control and Prevention.

This is sort of like the "losing everything while traveling" thread in that it probably freaks some people out. But really it is not that big of a deal, you just have to be prepared and educated. I have not used any anti-biotics in probably a year and a half now despite living in developing countries most of that time.

Kramer

[BigNick]

Quote:

Originally Posted by kramer It is hard to say what the root problem is when an anti-biotic does not help for stomach and diarrhea problems.

This is the first time I've heard of antibiotics being used for traveller's diarrhoea &c. We always carry loperamide; seems to do the trick. Maybe we're not visiting exotic enough countries, though.

[kramer]

Quote:

Originally Posted by BigNick This is the first time I've heard of antibiotics being used for traveller's diarrhoea &c. We always carry loperamide; seems to do the trick. Maybe we're not visiting exotic enough countries, though.

Nick,no loperamide is much better not to take when you have traveler's diarrhea. Better to let it run its course which loperamide can stunt. I pack loperamide although I have never taken it -- it is for when you have to go on a bus or plane and need to hold it.

Also, I think I was a little confused here. I generally only take anti-biotics when I have pain. If I just have a little diarreah I don't take it. Twice I have been in horrible pain and diarreah for 2 days. One other time might have developed into that without the anti-biotics. You had better have the medication with you in these situations.

That time, my Thai girlfriend and I had gone to an expat halloween party in Chiang Mai and we decided to eat at an outside restaurant specializing in sausage on the way home. There were probably 100 people there eating sausages. We both got sick. This was the genesis of the Kramer No Sausage Rule, lol.

Anyway, most people are not going to sick on short trips. Even during my "adventure travel" cycle, I was getting sick from about 1 in every 200-250 meals. But when you travel for months and years, you get hit sometimes.

Kramer

[Janet H]

My college aged kid just spent a year in Taiwan and mainland china. He reported that squat toilets were common. He also got sick - several times with food, human or water borne crud. In his taiwanese dorm there were distilled water dispensers in the bldg and all students including natives were using them for drinking water.

On two occasions he was sick enough with intestinal critters to need medical intervention. One of the big issues he had was that while there was ample opportunity for medical care, the standard of care can be different. Medications were dispensed unlabeled or or not in a language you read or were herbal. Take meds with you - you can always choose to not take them.

[DangerMouse]

Would have to agree with Kramer, China is probably the most unsanitary country I have ever been to. Don't believe that you won't get sick if you are really careful, my DH got so ill whilst he was there on a business trip that he ended up on a drip getting rehydrated and he was staying at a luxury hotel and not going anywhere dodgy. The squat toilets are probably the worst I have ever encountered, and I say that as someone who has lived in Pakistan and I thought that would take some beating.