Back to Basics

South of the border, it is turista or "the Aztec two-step." In Asia, visitors from the West call it "Delhi belly." By any name, traveler's diarrhea, a debilitating digestive upset caused by a change in the system's bacterial population, is a synonym for misery that can spoil a trip and jeopardize the victim's health. The standard prophylactic for many years has been Entero-Vioform, a drug so frequently used that it is the traveler's best friend. That fond relationship has come under challenge by the American Medical Association. The A.M.A. Journal has not only questioned Entero-Vioform's effectiveness, but cautions that its heavy use may lead to complications that make "Montezuma's revenge" seem mild by comparison.

The organization bases its warning on two factors. One is a lack of proof that Entero-Vioform actually prevents traveler's diarrhea. The other is a growing suspicion that the drug (iodochlorhydroxquin) is linked with a condition called subacute myelo-optic neuropathy (SMON), a nerve condition that can cause crippling and blindness. Entero-Vioform has been implicated in some of the 10,000 cases of SMON in Japan, where the drug used to be sold over the counter, while instances of the ailment have been reported in Sweden, Australia and the U.S. among patients who have taken it to prevent diarrhea.

Japanese officials have now banned Entero-Vioform outright, while Australia has eliminated over-the-counter sales. The U.S. Food and Drug Administration considers Entero-Vioform safe if used as directed and plans no action against the drug, which is sold in this country by prescription only.

The A.M.A. believes caution is essential. It recommends that physicians not prescribe Entero-Vioform prophylactically, but offer alternative advice: when in doubt, don't drink the water; when in distress, try paregoric.

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