We’ve seen a massive advertisement campaign from the makers of Dukoral during this busy travel season. These ads have definitely done a good job to get the conversation going about traveller’s diarrhea. And this conversation is an important one. Traveller’s diarrhea is one of the most likely health problems you may run into when going overseas.
Most of the time, I get two Dukoral related questions: “What does Dukoral do?” and “Should I get Dukoral for my trip?” I’ll attempt to answer both of those questions here.
What does Dukoral do?
There is a lot of information on the official Dukoral website that gets into a lot of detail, but I’ll summarize the best I can here. Dukoral is used to help reduce the risk of getting traveller’s diarrhea. You use Dukoral before you go on you trip. It does not help treat diarrhea when it happens.
Dukoral is an oral vaccine. We are used to most vaccines being injected, but there is a long history of vaccines that we have drank instead of injected. The original polio vaccine was in oral form. We still also have an oral version of typhoid vaccine.
What Dukoral does essentially is it protects the gut from the most common bacteria that can cause traveller’s diarrhea. We know that about 80% of the time when you get traveller’s diarrhea, it is from bacteria. There are several possible types of bacteria that can cause the diarrhea. The most common bacteria that causes diarrhea is enterotoxigenic Escherichia coli (ETEC). Dukoral helps to protect you against this type of bacteria. However, if the bacteria causing the diarrhea is not ETEC or is of another cause (virus or parasite as examples), Dukoral won’t be as effective. So this means that while Dukoral can provide a nice layer of protection against traveller’s diarrhea, it will not completely eliminate the risk of getting sick. You can’t just throw caution to the winds and eat whatever you want without consequences.
Should I get Dukoral for my trip?
I like to ask these questions when patients ask me about Dukoral.
Describe the details of your trip. Where are you going? For how long? Where are you staying? What types of places will you be eating at?
Dukoral can potentially provide some protection to anyone travelling. But for those unsure whether to get it, looking at your potential risk is a good exercise. For example, a traveller going to an all-inclusive resort in Mexico for a week may not be at quite as high a risk compared to someone backpacking in India for a month. I can see value in both of these travellers getting Dukoral, but I would probably more vigorously recommend it for the India traveller.
Do you have a history of issues when it comes to your stomach or gastrointestinal system?
Past history matters. If you have had troubles on previous trips, I would think it’s more important to provide the layer of protection that Dukoral will give. If you have existing gut problems, it’s also worth considering. People taking acid reducing medications such as Losec (omeprazole), Nexium (esomeprazole), Pantoloc (pantoprazole) among others are at higher risk of developing traveller’s diarrhea. Lower amounts of stomach acid, while useful when it comes to issues such as heartburn, decrease the body’s natural defenses against invasive bacteria, including the types that cause traveller’s diarrhea. If your gut has these or other pre-existing issues, maybe Dukoral should be considered a bit more.
How important is it for you to decrease your risk of getting traveller’s diarrhea?
How badly do you want to cover your bases and get that extra layer of protection that Dukoral provides? Maybe you are the bride at a destination wedding and you want to leave nothing to chance. Perhaps you have important business meetings and you want to ensure you will stay focused on work. Travellers in these examples are seeking every advantage they can find to not get sick. I would more strongly recommend Dukoral to them.
How much is price/budget a factor?
At Polaris, Dukoral costs $90 for the initial set of 2 doses (if you haven’t taken it before) or $50 for the single booster dose (if you have taken Dukoral within the last 5 years). We are able to directly bill prescription drug plans. If you bring in your drug plan information, we can check to see how much your drug plan will pay for Dukoral. If your drug plan reduces your out of pocket cost, it may be a bit easier to work into your budget.
Dukoral does not require a prescription, but your health care provider that can provide it for you (travel clinic, pharmacy, other) should be able to take the answers to these questions and give you a personalized recommendation about how much you should prioritize getting Dukoral before your trip.
What if I get diarrhea?
Whether you take Dukoral or not, you should also consider taking an antibiotic with you on your trip in case you get traveller’s diarrhea. Antibiotics to treat traveller’s diarrhea require a prescription, and you should consult with a health care provider that is knowledgeable about travel medicine. It is important that they pick out the right antibiotic for you based on your allergies, current medications, and your destination. At Polaris, we usually prescribe antibiotics to most of our patients that we see at a travel health consultation. We also educate them to recognize if they actually have traveller’s diarrhea and how to manage it. Then you can focus on your trip instead of wondering where the nearest bathroom is located.
There’s a lot of information here but there really is so much more that could be said. The info above should not be taken as specific individual medical advice. It’s written to help you think about what kinds of questions you should ask your health care providers about traveller’s diarrhea..
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