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Nov 2016
Travellers’ Diarrhoea by Shiraz Shaffi

Definition and Prognosis

Travellers’ Diarrhoea occurs whilst on or shortly after travelling abroad. It is caused by consuming contaminated food/drink which contains bacteria, viruses and parasites. Other symptoms include sickness, nausea, abdominal cramps, bloating and fever.

Diagnosis is usually defined as having 3 or more episodes of loose/watery stools accompanied by any one of the symptoms described above within a 24h period. Symptoms usually last between 3-5 days in mild cases, without the need of any specific treatment. More severe cases last 7-10 days and require hospitalisation.

Medical attention should be sought if faeces contain blood or mucous


There are a number of preventative measures that travellers can adopt to reduce the risk of coming into contact with the condition. Amongst these include;

1. Washing hands prior to eating/ drinking.

2. Using clean plates, utensils and cups by washing them with hot water

3. Carrying alcohol wipes whilst travelling.

4. Use bottled water where possible including water for brushing teeth

5. Boil any milk prior to use

6. Avoiding any food left over.

7. Avoid seafood and salads where possible

8. Peel all fruit including tomatoes whilst cleaning with hot water,

9. Avoid street food and stalls and always ask for hot food not warmed food.

10. Avoid places with swarming flies and food carried in pots.


Preventing dehydration is important. Approximately 3-4 litres a day is required to replace any lost fluids. Clear fluids such as diluted fruit juices or rehydration sachets (Dioralyte, Electrolade and Rehidrant) should be made up using clean water and consumed within 12 hours at room temperature or 24h if refrigerated

Loperamide (Imodium) can help stop diarrhoea. It is taken as a dose of 2 tablets initially followed by 1 tablet after each loose bowel motion up to a maximum of 8 daily. It is not recommended for children under 12 and treatment is recommended for no more than 3 days.

Bismuth Salicylates (Pepto-Bismol) is an alternative to anti-diarrhoea tablets. It is taken as either 2 tablets (or 30mls) four times daily but should be avoided by travellers taking aspirin or warfarin. It should be avoided in children under 16 and can cause blackening of stools and tongue. Treatment should not be continued more than 3 weeks.

Antibiotics may be used when other treatment is unavailable. They're effective against bacteria causing diarrhoea and symptoms usually improve in 24-48h. They are particularly useful for travellers going to remote area or with pre-existing conditions such as IBD, poorly controlled diabetes or renal impairment.

Most commonly prescribed include;

1. Ciprofloxacin at a dose of 500mg twice daily for 1-2 days

2. Azithromycin at a dose of 500mg once daily for 3 days

Another alternative treatment is Optibac Probiotic. It is specifically developed for travellers as an effective means of ensuring a healthy and well balance intestinal flora and works by strengthening the healthy balance of friendly bacteria in the gut by enhancing its protective capacity and binding to harmful bacteria and flushing them out. A dose of 1 capsule with breakfast each day starting 1 week prior to travelling, continuing whilst travelling and 1 week on return






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