This past Spring I had the privilege of attending the 16th conference of the International Society of Travel Medicine in Washington D.C. Among the interesting topics of the conference were talks about first aid kits (by Sheila Seed), natural medicines (Karl Hess and Derek Evans) and avoiding insect bites (Larry Goodyear). Canada’s own Sherilyn Houle (columnist for Pharmacy Practice + Business) also presented on how we as pharmacists can integrate travel medicine into our practices. All were great talks that helped pharmacists bring their patients up-to-speed in keeping healthy during and after travel.
I find it can be worthwhile to attend a CE session even when you think you know all you need to know about a topic. Often, doing so will will reinforce your confidence in what you are telling your patients; but you may also learn some interesting new ideas that you can add to your tool box to inform patients.
Having said that, many of the points reviewed during the conference reviewed common discussion topics—the things we would typically tell our travelling patients. Of course, the advice errs on the side of caution, keeping in mind that people may not be able to access any treatment at any given time while travelling. While the standard travel consult advice often includes assuming the patient will be dropped in the middle of the desert, common sense tells us that it’s possible to streamline their medical bag with a sit-down discussion that includes a plan for their actual destination.
Commonly-mentioned talking points for a travel consult include: pack meds in your carry-on bag; bring something for travellers’ diarrhea, nausea, pain, UTI and yeast infection, and pack plenty of sunscreen.
One important note is to add tweezers to your patient’s travel kit for safe removal of ticks, splinters or other items that may become embedded into the skin. And although as pharmacists we should always promote vaccines, this is especially true with travellers. I always have the most up to date edition of the CDC Yellow Book for recommendations to patients who are travelling, and most of us have customers who travel. Whatever helps to make you the “go to pharmacist” promotes your brand. Although as pharmacists we should always promote vaccines, this is especially true with travellers.
Latest research on natural supplements for travel
Natural supplements was a big topic at the conference. Here are some key takeaways:
Altitude sickness: Garlic, ginkgo biloba and vitamin E have been researched for their antioxidant and antiplatelet effects. None have been proven effective and all have an increased risk of bleeding or hemorrhagic stroke. (Source given was Micromedex and CDC Yellow Book).
Common cold while travelling: Echinacea, vitamin C and zinc are often asked about. 1-3 g daily of vitamin C, and zinc 9-24 mg daily (gluconate) have been shown to reduce the duration of the cold by 1-2 days in studies. Echinacea may reduce cold risk by 58% and reduce duration by 3 days. (All info based on CDC Yellow Book and Natural Medicines Database.)
Insect Repellents: Riboflavin and thiamine were both shown with negative results. Garlic dosed at 1200 mg daily for 8 weeks showed a reduced incidence of tick bites, but no supporting evidence for other bite sources. (Source: Natural Medicines Database for all)
Jet Lag: Fairly good evidence here for kava, melatonin and valerian. Kava’s rationale is as an anxiolytic and shows evidence for 100mg-200mg for anxiety associated insomnia with a safety issues involving hepatotoxicity. Melatonin has been researched here for alertness and daytime fatigue/performance. Melatonin at 0.5-5 mg at bedtime has been shown to be beneficial for eastbound flights over 5 or more time zones. It is unclear if this effect happens in westbound flights. Valerian has been tested for its possible effects on sleep quality and sleep latency. Using 400-900mg 2 hours prior to sleep is generally well tolerated and may improve sleep quality by up to 80% and decrease sleep latency by 14-17 minutes. It should be tapered if used for long periods of time. (references cited were Micromedex, Natural Medicines Database and CDC Yellow Book).
Motion Sickness: Ginger and pyridoxine. Ginger at 500 mg-1000 mg 4 hours prior to travel has shown conflicting subjective improvement in both nausea and increased latency before onset of nausea. Pyridoxine dosed at 10-25 mg every 8 hours has no supporting evidence for motion sickness (CDC Yellow Book, Micromedex and Natural Medicines Database)
Prebiotics and probiotics in travellers’ diarrhea: To say the least, study results are all over the map. Early studies and meta-analysis showed safe and effective conclusions in studies. We became aware of the need for specific strains in making recommendations. This makes meta-analyses difficult because of the number of strains tested. A specific prebiotic, B-GOS has been shown to have positive results in travellers’ diarrhea, especially if started a week before the trip. I personally recommend saccharomyces boulardii in prevention.
Mosquito repellents: When it comes to mosquito repellants, don’t mess around— use DEET at the highest concentration available (i.e. 50%). Apply 0.5-1g per arm (1mg/sq cm). Nets treated with a pyrethroid have excellent evidence for efficacy and disease prevention.
Those are just a few highlights that may be helpful in your consults with patients preparing to travel. You don’t have to label your pharmacy as a Travel Medicine Clinic to be helpful to your customers. Regardless of your current level of comfort in making travel recommendations, I would highly recommend attending an International Society of Travel Medicine conference (with which, by the way, I have no connection or affiliation). You may convert a perceived niche offering into a welcome strengthening of your pharmacy toolbox.