Treatments for travellers' diarrhoea
Travellers' diarrhoea: preparing for infection
Travellers to North America, Europe, or Australasia do not generally require antibiotic for diarrhoea.
Travellers most likely to benefit from antibiotics:
- Going to remote rural areas distant from medical help.
- With pre-existing bowel problems such as inflammatory bowel disease where infection may trigger a relapse e.g. ulcerative colitis, Crohn's disease, coeliac disease, and previous bowel surgery.
- with pre-existing medical conditions which may be worsened by severe infection or dehydration, e.g. poorly controlled diabetes, renal impairment, heart failure, HIV, and reduced immunity.
- With a tendency to severe travellers' diarrhoea (on the basis of previous travel experience) or taking immunosuppressive treatment.
Between 20% and 50% of travellers from the West visiting resource-poor countries get travellers' diarrhoea. It usually starts within the first week of arrival.
As many as 5 million people from the UK suffer from travel diarrhoea each year.
Taking an antibiotic on a trip can reduce significantly the severity and duration of travellers' diarrhoea, but only if the diarrhoea is caused by bacteria - see below causes of diarrhoea.
A short course of the antibiotic azithromycin together with the antidiarrhoeal Loperamide is effective in treating travellers' diarrhoea. An anti-sickness tablet such as Avomine will also relieve symptoms and help to prevent dehydration. Avomine should not be taken at the same time as the antibiotic azithromycin. Anti-diarrhoea treatments work best if taken as soon as diarrhoea starts.
Anti-diarrhoea treatment should not be taken if there is blood in the stools, or there is a high fever (38.5°C), or severe abdominal pain, which could be signs of inflammatory bowel conditions.
Causes of diarrhoea
Travellers' diarrhoea is usually caused by bacteria (80% of cases) the body is not used to. Travellers' diarrhoea can also be caused by other bacteria, such as salmonella, by giardia, viruses (15%), and toxins in food and water.
How long does travellers' diarrhoea last
Travellers' diarrhoea usually lasts 1 to 7 days during which time a small proportion of people are bed bound. Symptoms can last up to one week (10%) or two weeks (5%) or longer. In a few cases (about 1.5%) travellers' diarrhoea can lead to serious illness and even long-term bowel problems.
People with serious medical conditions and a history of bowel disease should seek medical help if they get severe diarrhoea. If there is blood and mucus in the diarrhoea, or diarrhoea and vomiting continues for more than 2 days, or there is high fever (38.5°C for 48 hours) and severe abdominal pain, or a rash, then medical help is required.
The biggest danger with diarrhoea is dehydration. People with diarrhoea should drink plenty of fluids (3-4 litres per day), even if they are continuing to vomit. All fluid except milk will help although specialised rehydration fluid is best.
- Avoid street food or places that appear dirty
- Drink bottled or boiled drinks (boil for at least 1 minute).
- Fruit that can be peeled is safe
- Avoid shellfish and salads
- Be careful about hand washing - using soap and water is probably better than hand gel.
- Sometimes ice cream and ice can be contaminated
All people who are travelling should be up-to-date with the recommended vaccines - see the NHS Fit for Travel website for advice.
- NICE, 2019, Diarrhoea - prevention and advice for travellers, accessed 5 July 2019
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