Traveller’s Diarrhoea: Prevention, Symptoms, and Treatment

Traveller’s diarrhoea is a common digestive tract disorder that commonly affects UK residents travelling to regions with different standards of hygiene or sanitation. It is defined as the passage of three or more unformed stools in a 24-hour period, often accompanied by abdominal cramps, urgency, and nausea.

The condition is typically caused by ingesting bacteria, viruses, or parasites. According to NICE guidance, the most frequent culprit is enterotoxigenic Escherichia coli (ETEC). While often referred to by colloquial names like 'Delhi Belly' or 'Montezuma’s Revenge', the impact on a holiday or business trip can be significant, leading to dehydration and missed activities.

Symptoms of traveller’s diarrhoea usually begin abruptly during a trip or shortly after returning home. Most people experience:

• Frequent loose or watery stools
• Urgent bowel movements
• Abdominal cramping and bloating
• Nausea and, occasionally, vomiting
• A low-grade fever
• General malaise and fatigue

The primary cause is the consumption of contaminated food or water. High-risk areas often include parts of Central and South America, Africa, the Middle East, and Asia. Poor hand hygiene by food handlers or using local tap water for ice cubes are frequent sources of infection.

Prevention is the most effective strategy when travelling to high-risk destinations. Following strict food and water hygiene can significantly reduce your risk. A useful mantra for UK travellers is: 'Boil it, cook it, peel it, or forget it.'

Safe Eating Habits

• Eat food that is served steaming hot.
• Avoid raw vegetables and salads, which may have been washed in local tap water.
• Only eat fruit that you have peeled yourself, such as bananas or oranges.
• Avoid unpasteurised dairy products.

Safe Drinking Habits

• Stick to sealed bottled water or water that telah been boiled.
• Avoid ice cubes in drinks, as these are often made from tap water.
• Use bottled water for brushing your teeth.
• Be cautious with fresh fruit juices which may be diluted with local water.

Most cases of traveller's diarrhoea are self-limiting and do not require specific medical intervention. The cornerstone of management is preventing dehydration.

Rehydration

Drink plenty of fluids, such as bottled water, diluted fruit juices, or clear soups. Oral Rehydration Salts (ORS) available from UK pharmacies are highly recommended. These sachets contain a specific balance of salt and sugar to help your body absorb water more effectively.

Dietary Changes

While recovering, stick to bland foods. The 'BRAT' diet (Bananas, Rice, Applesauce, Toast) is often suggested, though the most important factor is returning to a normal, healthy diet as soon as you feel able. Avoid caffeine, alcohol, and heavy, fatty foods until symptoms have fully cleared.

Medication

Anti-motility drugs like loperamide can help reduce the frequency of bowel movements. However, these should be avoided if you have a high fever or bloody stools, as they can slow down the clearance of the infection from your system.

In the UK, routine use of antibiotics to prevent traveller's diarrhoea is not recommended for most people due to the risk of side effects and antibiotic resistance. However, for those travelling to high-risk areas or those with underlying health conditions (such as inflammatory bowel disease or a weakened immune system), a GP may prescribe a 'standby' course of antibiotics.

Azithromycin is often the preferred choice for standby treatment in certain regions. This is only to be used if symptoms are severe (e.g., interfering with planned activities) or if you are unable to access medical care. It is essential to follow the dosage instructions provided by your healthcare professional strictly.

While most traveller's diarrhoea settles within a few days, some cases require professional medical advice. You should consult an online GP if your symptoms do not improve within 48 to 72 hours, or if you are concerned about your recovery.

An online GP can help review your symptoms, advise on the best rehydration strategy, and determine if you require a prescription for antibiotics or further diagnostic tests, such as a stool sample. If you have recently returned to the UK and are still experiencing symptoms, it is important to mention the countries you visited to help identify potential parasites or specific bacterial strains.