FYI - Gastro prescription - Chennai Oct 2012

Hi

just for your collective information, I paid 600rp yesterday for a Doctor to prescribe the following over-the-counter Gastro medication - total cost of the medication was INR 183. It seems to be working, took it all first sign of onset, only one bout of 'explosion', and plenty of sleep now:

ZENFLOX-OZ - 3 tablets/day - 3 days
ELDOPER (hydrochloride capsules) - 2 tablets/day - 2 days
DOLO 650 - 3 tablets/day - 2 days
'EMESAG 20375' (Cant read the Doctor's handwriting on this one, there may be a typo) - 2 tablets/day, 2 days

also prescription was pomegranates and apples, rice, idli, jam sandwich, basically anything to cool the stomach down.

Hope this may save some of you INR600

best wishes Sue

₹ 600 for a consultation seems a bit high. Where/Which hospital was it?

Also I would not blindly use someone else's prescription on myself. The conditions/symptoms may look similar for a number of very different afflictions.

Sue,

Sorry to be tough, but why on earth don't you have a traveller's medical kit?

As for your drugs -

Dolo is paracetamol (Panadol or Panamax depending on which you buy at home)

Edloper is Loperamide (Gastro-stop or Immodium)

Zenflox is an all-purpose anti-biotic - used for both Giardiasis and amoebic dysentery.

At the risk of repeating myself:

• Basic Rules: Care in what you eat and drink is the most important health rule; stomach upsets are the most likely travel health problem (about a third of travellers in a two-week stay experience a mild stomach upset) but the majority of these will be relatively minor. Don’t be paranoid; trying the local food is part of the experience of travel. Homestays are a great place to really tuck into the food, as it is prepared fresh and with care, so is the most hygienic and safest to eat.

• For Westerners, it is important to adjust your personal hygiene to suit the different Indian environment. There are some common sense precautions to keep in mind. Clean your teeth from purified/bottled water rather than straight from the tap. Be extra careful with your health in climatic extremes: keep out of the sun when it is hot, dress warmly when it is cold. Avoid potential diseases by dressing sensibly; you can avoid insect bites by covering bare skin when insects are around, by screening windows or beds and by using insect repellents. Wash your hands thoroughly or use an anti-bacterial gel before eating.

• Water. The number one rule is don’t drink the tap water and that includes ice. If you don’t know for certain that the water is safe always assume the worst. Reputable brands of bottled water or soft drinks are generally fine, although in some places the practice of refilling bottles with tap water is not unknown. Only use water from containers with a serrated seal, not tops or corks. Take care with fruit juice, particularly if water may have been added. Milk and yogurt are generally fine. Tea or coffee should also be OK, since the water should have been boiled, and the majority of the drink will be milk.

• Food. There is an old colonial adage that says: ‘If you can cook it, boil it or peel it you can eat it...otherwise forget it’. Salads and fruit should be washed with purified water or peeled where possible. Ice cream is usually OK if it is a reputable brand name, but beware of street vendors and of ice cream that has melted and been refrozen. Thoroughly cooked food is safest but not if it has been left to cool or if it has been reheated. Shellfish such as mussels, oysters and clams should be avoided as well as undercooked meat, particularly in the form of mince. Steaming does not make shellfish safe for eating. It’s a good sign if a restaurant looks clean and well run and if the vendor also looks clean and healthy. In general, places that are packed with locals, will be fine, while empty restaurants are questionable. The food in busy restaurants is cooked and eaten quite quickly with little standing around and is probably not reheated.


A medical response to diarrhoea - stay hydrated - something like Gastrolyte or Hydralyte (these are available as fizzy tablets - take some with you) is the best option. Antibiotics to kill the bacteria include ciprofloxacin or azithromycin or norfloxacin. You can get these without prescription in India. Loperamide (or immodium) is just a stopper, but can be useful if you have to travel.

Amoebic dysentry - incredbly unlikely. Tinidazole or Metronidazole.

Giardiasis - more likely that amoebic dysentry - same drug response.


If you arrange a comprehensive traveller's medical kit before you go, it will (should) include all you need.

Hi guys

thanks for the tips and clarification! The Doctor came as room service, from the hostel. I actually thought the symptoms were Malaria, so that's why I called the Doctor (aching muscles and lymph node under my arm).

Good idea about travel kit. I will certainly stock up on those items. In the past I've always travelled with raw garlic, and would eat a raw clove each night - however had let this slip!

Ive been here 3 months altogether. No problems until now. Can trace this gastro back to 2 days ago when I dropped my guard - had ICE in a bar, and also ate a made-to-order dish from an unseen source, not the usual thali.

thanks again

Don't try to save the money. See a doctor, and get a prescription for your illness, not Sue's!

Exactly.

Because she did the right thing, saw a doc and bought the right medicines.
Not so bad then, as the hotel probably took 70% of it. In the doc's clinic you might have paid one or two hundred.
Not a doctor, but in my experience, tummy upsets occur with six to 24 hours of what it was you ate, not two days.

Getting better is the main thing: hope you're well and active again soon

Sorry Nick, not at all. In Sue's country we are encouraged to get the appropriate vaccines before travel; and to buy a traveller's medical kit complete with medications and very specific instructions for the treatment of common traveller ailments, suited to the destination.

Even I do not expect people to run to the doctor for an ailment they are perfectly capable of diagnosing themselves.

A case of diarrohea and a doctor suggests paracetamol and Imodium. Who'd have thought?!!! These are, as Sue described, over the counter medicines and most adults would know when to take them and when not.

And the antibiotic Sue has is not specific to any one bacteria. There appears to have been no test to establish the bacteria, therefore the antibiotic is, well, not necessarily misguided, but certainly unguided, and Sue, frankly, should have been carrying those items with her.

Without putting people off their dinner, Giardia is indicated by mild, persistent yet foul smelling diarrhoea for a week or more, particularly if associated with khaki coloured motions, and bloating and loss of appetite and tiredness.

Amoebic dysentery on the other hand is indicated by bloody diarrhoea, fever, abdominal pain and weight loss. If it is AD then you need to take those tablets with a meal, and no alcohol during those three days or for two days after. And for God's sake see a doctor when you get home.

@Sue - re Malaria - well, firstly you need to have been bitten by a mosquito; so I trust you are taking action to avoid that. Secondly, it's likely to be flu-like symptoms (fever, shivers, headache, muscle soreness) after 7 days in a malarial area. Malaria also requires blood tests. If you have any fever when you get home, please see a travel doctor.

Dengue Fever is the other mosquito option (they get this in Queensland you would know) so as above but plus a rash and strange tastes.

Keep well.

How "frankly" is that, when they are available from a local shop within a block or two?
Oh yes, I used to do that. It even has sterile needles and stuff. I still have it. All of it. Fifteen years later!

The reality is that the people who write that stuff do not recognise that normal medical assistance and normal medicines are fully available here. Some of us travel with everything conceivable, and that's fine too (You can probably find a pill for headache/stomach ache at the bottom of my every-day baag) --- but should have is way too strong.

Hi Nick
thanks for that :-) but I really got a bit cocky about 'not getting sick' and was quite proud to tell people that I've travelled in India several times and never got sick..... all under the influence of raw garlic and healthy eating mind you

However, having said that, and in reply to a couple of posts above, the medication for Gastro seemed pretty generic. The Doctor took my pulse for a long time (ayurvedic influence?) and then just said 'acute gastro' - the symptoms were aches, runs, vomiting, dizzy, chills and fever. So in sharing his prescription, I was thinking that it might save someone a trip to the Dr if they are stuck - and Dr Rudi has very kindly provided more details of what the medications actually do. Anyhow so far so good, all symptoms have stopped apart from lethargy and no appetite.

Also while on the topic though, Narendra did have a good point - I did originally think it was malaria (similar symptoms?) - and so seeing the Dr helped to remove this worry. Incidentally Dr Rudi - I don't know how you avoid mosquito bites here - the stealthy buggers manage to find the tiniest bit of skin which hasn't been sprayed, and the repellant sweats off in this Chennai heat........

It's almost impossible to avoid the mossies, and the climate (which I'm used to) is, err, rather sweaty at the moment.

I do wonder how your doc diagnosed the "gastro" from your pulse, but if it is getting better, that's all that counts. We have so many Chennai members: if you do need a medical recommendation, just let us know what area you are in and I'm someone will be able to help with a doctor's name.

Of course, the main point in having something in your bag for the common pains in life is that you can take it without having to go out, which might be the last thing in the world that you want to do. That is true anywhere in the world. It gets truer if you are shut in to a plane or train tip!

thanks!