Travellers' diarrhoea
Contaminated food and drink are the major sources of stomach or intestinal illness while travelling. Intestinal problems caused by poor sanitation are much more common outside industrialised nations. Most cases of travellers' diarrhoea are caused by an infection in the gut and most of these are bacterial infections. Local people are repeatedly exposed to these bacteria during childhood and build up immunity to them.
Symptoms
The typical symptoms of travellers' diarrhoea are diarrhoea, nausea, abdominal pain and cramps. There may also be vomiting and fever. Travellers' diarrhoea usually lasts a few days. It is rarely life-threatening in otherwise healthy people.
Areas of high risk include the developing countries of Africa, the Middle East, Latin America and Asia.
Travellers' diarrhoea is usually acquired through eating or drinking food or water that has been contaminated by faeces.
Prevention
The best way to prevent diarrhoea is by paying meticulous attention to your choice of food and drink, and by being careful about personal hygiene. Always wash your hands after going to the toilet and before eating. Small bottles of handwash gel or hand sanitiser are ideal for this purpose.
The risk of infection does not necessarily depend on the type of eating establishment you visit. For example, although food from street vendors can be very risky, so can food that has been kept at room temperature for long periods in hotels and restaurants. Therefore, travellers should take precautions with all food and drink, including that served in good-quality hotels and restaurants.
Safe foods include fruits that you peel yourself, bread and other dry foods, and steaming hot cooked food. Unsafe foods include unpasteurised dairy products, salads, dishes containing raw or undercooked eggs, raw meats and raw seafood, ice cream from unreliable sources such as street vendors, and food that has been kept at room temperature for several hours, for example in buffets or street markets.
Safe drinks include recently boiled water e.g. that used in tea and coffee, canned or bottled soft drinks, beers and wines. Unsafe drinks include tap water and ice. When bathing, showering or swimming, avoid swallowing the water. Don’t clean your teeth with tap water. Wipe and dry the opening of canned or bottled drink before you put it to your mouth.
You can treat tap water to make it safe by:
- boiling it for several minutes (this is the most effective way to kill disease-causing bugs);
- adding iodine or chlorine as a water purifying agent (tablets or solutions are available from pharmacies) — iodine products kill a wider range of bugs than chlorine products, but neither are effective against Cryptosporidium; or
- using a portable water filter (although the effectiveness of these may vary).
Unless water is boiled, then a combination of methods, such as filtration followed by chemical disinfection, is recommended.
Treatment
Antibiotics are not usually recommended to prevent travellers' diarrhoea (only to treat it) because they can cause additional problems themselves.
For treatment, clear liquids such as water should be drunk. If moderate to heavy diarrhoea continues, then oral rehydration solution is advised as it replaces both the fluid and the salt lost in diarrhoea - especially for children, who are more vulnerable to dehydration than adults. Avoid all beverages that contain water of questionable quality and dairy products, but continue to breastfeed your baby even if it has diarrhoea.
Antibiotics such as norfloxacin or azithromycin may be used to treat travellers' diarrhoea and may shorten the length of illness. Consult your doctor for a prescription and instructions on how to take these antibiotics.
Antidiarrhoeals such as Lomotil (diphenoxylate-atropine) or Imodium (loperamide) can decrease the number of diarrhoeal stools; however, as they work by slowing down the passage of the gut's contents, they can cause complications for people with serious infections by delaying the expulsion of the infectious agent via the diarrhoea. They should never be used if a person has a fever or bloody diarrhoea.
Treatment for children and infants
It is important to ask a doctor about treatment of diarrhoea in children and infants, because some of the medications mentioned are not recommended for them.
The greatest risk for children, and especially infants, is dehydration. Make sure children are kept hydrated by drinking clean water or diluted lemonade, fruit juice or cordial. Children with diarrhoea who show signs of mild dehydration, such as thirst and restlessness, should be given oral rehydration solution to drink. This is a packet of salt and carbohydrates that should be prepared following the package instructions and using boiled or treated water. Dehydrated children should drink this often and as much as they want. Breastfed babies can also drink this solution but should be allowed to nurse on demand. It is a useful precaution to take some rehydration sachets, such as Gastrolyte or Hydralyte, in your holiday medical kit.
When to see a doctor
Seek medical help straight away if:
- a child has bloody diarrhoea, dehydration that is moderate or severe, fever in excess of 38.5°C, or persistent vomiting;
- a baby develops diarrhoea while travelling;
- a pregnant woman develops diarrhoea; or
- someone with a long-term medical condition, such as heart disease, develops diarrhoea.
Adult travellers should seek medical help if diarrhoea does not get better within a few days, if it is bloody or very frequent and watery, if it is accompanied by repeated vomiting, fever or chills, or if they are unable to drink enough fluid and become dehydrated.
Last Reviewed: 01 December 2010
- 1. World Health Organization. World Health Organization. Environmental health risks. In: International travel and health: situation as on 1 January 2010. Geneva: WHO; 2010: 30-48. http://www.who.int/ith/en/ (accessed Dec 2010).
2. State Government of Victoria Department of Human Services. Gastroenteritis in children. June 2008. http://www.health.vic.gov.au/edfactsheets/gastro-kids.pdf (accessed Dec 2010).
