Order antibiotics for travellers' diarrhoea

Traveller’s diarrhoea is a common issue for people travelling to places in Asia, Africa and South America. There is a 60% probability you will experience diarrhoea in your first week. Azithromycin is fast acting and an effective an

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What is Traveller’s Diarrhoea?

Traveller's diarrhoea is a common symptom which can occur after or during travel and is characterised by passing three or more watery stools within 24 hours. It is often caused by bacteria present in food, water or utensils due to different hygiene standards. It can also be brought on by eating different foods from usual, such as dishes which are spicy or oily. 

Where would I be at risk of Traveller’s Diarrhoea?

Certain countries provide a high risk of traveller's diarrhoea due to different hygiene practices. These destinations include: 

  • Central and South America
  • Mexico 
  • Africa 
  • Asia 
  • The Middle East

Symptoms

What are the symptoms of traveller’s diarrhoea?

 The main symptom of traveller's diarrhoea is passing watery stools at least three times within a 24 hour period. Other symptoms can include:

  • Cramps
  • An urgent need to go to the toilet
  • Nausea 
  • Fever 
  • Vomiting 

Does vomiting and diarrhoea affect any other medication you may be taking i.e. antimalarials?

Vomiting straight after taking medication may mean it hasn't been absorbed correctly by the body. In general, it takes 30 minutes for medication to be absorbed into the bloodstream but tablets which have a gel coating will take longer. If you vomit after taking an antimalarial then you may not be protected against malaria. If this happens, take another dose or check with a doctor if you are unsure about what to do.

How long does Traveller’s Diarrhoea last?

Traveller's diarrhoea lasts for up to 3-5 days. After this your symptoms should clear up and you'll feel well again. 

What is mild vs severe traveller’s diarrhoea?

Mild traveller's diarrhoea is defined as having three watery stools within a 24 hour time period. You may also experience stomach cramps, nausea, vomiting and a fever. Severe traveller’s diarrhoea results in passing six or more watery stools in 24 hours and may include bloody stools, significant vomiting, pain and fever. 

How is traveller’s diarrhoea diagnosed?

A formal diagnosis is not required for traveller's diarrhoea. Severe diarrhea will need medical attention and this is defined as having passed six or more watery stools within 24 hours in addition to bloody stools, vomiting, pain or fever. 

How quickly does the treatment work?

For severe traveller's diarrhoea, antibiotic treatment will take 1-2 days to work. Treatment such as Imodium for mild diarrhoea will start to work after an hour or two. Traveller's diarrhoea will usually resolve on its own without treatment in 3-5 days. 

What are the options for prevention and treatment for traveller’s diarrhoea?

Awareness of hygiene and being careful with food and drink consumption are the best ways to prevent traveller's diarrhoea. Wash your hands thoroughly, using antibacterial hand gel where hand washing facilities are not accessible and ensure the food you are eating is hot and cooked thoroughly. Prophylaxis may be prescribed as a preventative treatment for people with underlying conditions such as inflammatory bowel disease.  

Treatment is not usually necessary if the symptoms are mild to moderate. Imodium (Loperamide) can be taken to treat mild diarrhoea and intravenous hydration may be needed for severe traveller's diarrhoea. If you are unable to access medical assistance self-treatment with antibiotics is an option. Ciprofloxacin should be taken in this situation as a 500mg dose twice a day. If this proves to be ineffective after 3-4 days then switch to Metronidazole.   

Treatment

How to prevent Traveller’s Diarrhoea

Traveller's diarrhoea can be prevented by practicing good hygiene and taking precautions with food and water consumption. Wash your hands thoroughly and often, particularly after using the toilet. Only consume foods which are freshly cooked and hot, avoiding high-risk foods like meat if you are unsure of the quality. Stick to drinks purchased in sealed containers, wiping the rim clean before consuming and avoid ice unless you know it has been made from clean, uncontaminated water.  

How to treat traveller’s diarrhoea

If you experience traveller's diarrhoea the first thing you should do is to make sure you drink plenty of fluids to avoid dehydration. Oral rehydration salts are recommended and are available from a pharmacy. Medicine such as Loperamide is designed to treat mild to moderate diarrhoea and is suitable to treat traveller's diarrhoea. Severe diarrhoea which is accompanied by vomiting, fever, pain or bleeding will need medical attention. Self treatment with antibiotics such as Ciprofloxacin is an option if you are in a rural area or unable to get to a doctor or hospital. 

What should I do if I get traveller’s diarrhoea?

If you get traveller's diarrhoea you should drink plenty of fluids to prevent dehydration. Ensure you mix rehydration salts with clean water and continually sip liquid rather than drinking it down too quickly. In most cases, further treatment is not needed unless the diarrhoea is severe. This is defined as passing 6 or more watery stools alongside other symptoms like vomiting, fever, bleeding or pain. In this case, seek medical attention or take antibiotics if you are in a remote location or unable to access medical care. It is also essential to rehydrate and keep drinking clean water. 

Is there a vaccine for traveller’s diarrhoea?

There is no vaccine available in the UK for traveller's diarrhoea. In the majority of cases, antibiotics are not necessary to treat traveller's diarrhoea and it will resolve on its own with adequate re-hydration in 3-5 days.

Do you need to treat traveller’s diarrhoea or will it resolve on its own?

Traveller's diarrhoea does not usually cause complications and will resolve on its own in most cases. If it is severe then you will need to seek medical attention or take antibiotics if you are unable to access medical assistance. 

Q&A

Is traveller’s diarrhoea a form of food poisoning?

Traveller's diarrhoea is not classed as food poisoning but it can be caused by contaminated food or drink in locations where the food hygiene standards are different from what you are used to. 

Can traveller’s diarrhoea be passed from person to person?

Traveller's diarrhoea is contagious and can be passed from one person to another. To avoid spreading bacteria, wash your hands regularly and do not share contaminated food or water.

Does the time of year I travel affect how likely I am to experience traveller’s diarrhoea?

The highest risk for traveller's diarrhoea is visiting South Asia during the hottest months before the monsoon season begins. Travelling during these times of the year increases the risk of coming into contact with contaminated water as there may be limited supplies of fresh or clean water. 

Is traveller’s diarrhoea always caused by E Coli?

Traveller's diarrhoea is almost always caused by bacteria such as E Coli but it can also be caused by Salmonella, Giardia and norovirus. 

Is all E Coli dangerous?

The majority of E-coli are not dangerous and live naturally within the gut. The bacteria can live outside of the body through faecal contamination, leading to stomach related illness. Certain strains of E-coli produce toxins which cause serious illness, for example E. coli 0157.

Is traveller’s diarrhoea dangerous?

In most cases, traveller's diarrhoea is not dangerous. It will usually pass without needing further treatment other than rehydration. Traveller's diarrhoea can be dangerous if it is severe or if you have a medical condition where flare ups of diarrhea can cause complications. You should see a doctor if this happens or if you are worried at any point. 

How difficult is it to get treatment for traveller’s diarrhoea abroad?

Treatment for traveller's diarrhoea is only necessary if it is severe. Getting access to medical treatment may depend on where you are. In rural areas, you may not be able to get to a doctor. If this happens, you can self-treat traveller's diarrhoea with antibiotics. Ciprofloxacin is the most effective antibiotic for diarrhoea and should be taken twice a day in 500mg doses. Metronidazole can also be taken. 

What should I do if I get traveller’s diarrhoea and I’m pregnant?

If you get traveller's diarrhoea while you are pregnant, it is essential to stay hydrated and keep eating, even if you don't feel hungry. Avoid medication if necessary as this can harm the baby.  

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