South East Asia Stomach Aches

This revision is from 2026/04/22 05:52. You can Restore it.

When the water is contaminated, everything is contaminated. The water used in beverages, food, showering and so if there is a consistent pathogen in the water everyone eventually has it. The locals might be more resilient while foreigners become ill. The locals are not aware that their water is not drinkable from the tap and that they need to upgrade their water treatment systems by either fluoridation and constant upgrades. The locals that make beverages and food in restaurants are not aware that they need to be using bottled water for foreigners. This is also the situation with any pets that travel with people, the pets cannot handle the local water supply or the food that is made from it. If you use pet day care, you must remember to instruct them and supply them with bottled water.

Sanitary standards are generally low.

This type of pathogen may not exhibit as pain, it may permanently exhibit itself as bloating or intolerance to specific foods. After sufficient re-dosing it may exhibit itself as upper and lower abdominal pain, that gets worse and worse with re-dosing.

This differs from a medical issue such as gynecia of the intestines.

People assume food poisoning as the worst of it. It is not, some pathogens set up shop in the intestines and never leave causing pain everytime food is consumed.

Understand that re-ingestion of the local food re-contamiantes the intestines. You now are restricted to supermarket foods that have international food seal such as bottle caps that break open, firmly shut to avoid contamination. First ingestion may be fine, second ingestion might be fine also, by the third day of ingestion of local food and the stomach ache begins to appear and only gets worse with subsequent ingestion.

Here is the protocol.

Day 1: Ivermectin: 18mg 2 times 24 hours apart

Day 3: Day off

Day 4: Albendazole: 400mg once daily 3 days

Day 7-17: Day off

Day 18: Repeat Albendazole 400 mg in 2 weeks

Day 15: Day off

Day 16: Praziquantel Typically 5–10 mg/kg - 80 kg x 75 mg/kg = 6,000 mg per day. 2,000 mg three times a day (totaling 6,000 mg) 2 Days

Day 18: Day off

Day 19: Triclabendazole 10 mg/kg 800 mg for 80kg, second dose is given 12-24 hours later.

Day 21 Take 1 week off, let gut heel if all is resolved then do not proceed futher. Eat early, eat lightly. If not resolved.

Day 28: Metronidazole 450-500mg 3x per day 7 days

Day 18: Day off

Day 36 Azithromycin 500mg once daily for 1-3 days or (one or the other but not both) Amoxicillin-clavulanate 500/125mg 2 times a day, every 12 hours for 10 days

Do not re-ingest local made food.

Day(s) Medication & Dosage Target Symptom / Condition Duration & Frequency Day Off / Rest Stop if Symptoms Cease? Clinical Notes
1–2 Ivermectin 18 mg
(Typical adult dose; ~0.2–0.4 mg/kg for 45–90 kg)		 Nematode infections, unexplained GI discomfort, larval migration 1 dose every 24h (2 total) ✅ Day 3 ❌ Complete both doses Take on empty stomach. Space exactly 24h apart.
Monitor for dizziness or rash.
3 — (Rest Day) Recovery & clearance — ✅ Yes N/A Allow hepatic/renal processing. Hydrate well.
Track symptom changes.
4–6 Albendazole 400 mg
(Standard adult dose; weight-independent)		 Soil-transmitted helminths, bloating, abdominal cramping Once daily × 3 days ✅ Day 7 ❌ Complete full course Take with a fatty meal for optimal absorption.
May cause mild GI upset.
7 — (Rest Day) Recovery & clearance — ✅ Yes N/A Monitor for late parasite clearance signs.
Log stool changes.
8 Praziquantel 5–10 mg/kg
≈ 400–800 mg (80 kg man) | 325–650 mg (65 kg woman)		 Trematodes/Cestodes (flukes/tapeworms), persistent diarrhea Single dose ✅ Day 9–13 ❌ Must take full calculated dose Weight-based. Take with water & light food.
Dizziness/nausea common; rest after dosing. Confirm exact dose with clinician.
9–13 — (Rest Days) Extended clearance window — ✅ Yes (5 days) N/A Allow complete parasite die-off & toxin clearance.
Avoid alcohol & heavy meals.
14 Albendazole 400 mg
(Standard adult repeat dose)		 Repeat helminth eradication, relapse prevention Single dose ✅ Day 15 ⚠️ Confirm with clinician Targets late-hatching stages.
Verify if asymptomatic before proceeding.
15 — (Rest Day) Recovery — ✅ Yes N/A Prep for antibacterial phase.
Assess symptom baseline.
16–22 Metronidazole 450–500 mg
(Standard adult TID dosing)		 Protozoa (Giardia/Amoeba), SIBO, foul-smelling diarrhea 3× daily for 5–7 days Day 23+ ❌ Do not stop early Strictly avoid alcohol during & 48h after.
Metallic taste & dark urine are normal.
23–25 Azithromycin 500 mg
(Standard adult dose)		 Bacterial GI pathogens, traveler's diarrhea Once daily × 1–3 days — ⚠️ May shorten if resolved (MD guidance) CHOOSE ONE: Azithromycin OR Amox-Clav
Take with food if GI upset occurs.
23–32 Amoxicillin-Clavulanate 500/125 mg
(Standard adult BID dosing)		 Broad-spectrum bacterial coverage, dysentery 2× daily × 10 days — ❌ Complete full 10-day course CHOOSE ONE: Alternative to Azithromycin
Take at start of meals. Watch for diarrhea.

  

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