Travellers' diarrhoea
Contaminated food and drink are the major sources of stomach or intestinal illness while travelling. Intestinal problems due to poor sanitation are found in far greater numbers outside the industrialised nations. The majority of cases of travellers' diarrhoea are caused by an infection in the gut. Most of these are bacterial infections. Local people are repeatedly exposed to these infections during childhood and build up immunity to them.
Symptoms
The typical symptoms of travellers' diarrhoea are diarrhoea, nausea, urgency, abdominal pain and cramps. Travellers' diarrhoea usually lasts a few days. It is rarely life-threatening in 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. The risk of infection varies depending on the type of eating establishment you visit, for example, food from street vendors can be very risky.
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, raw meats and raw seafood, and food from street vendors.
Safe drinks include recently boiled water including 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;
- 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; or
- using a portable water filter (although the effectiveness of these may vary).
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 should be drunk. Oral rehydration solution is advised as it replaces the fluid and the salt lost in diarrhoea — especially for children, who are more vulnerable to dehydration than adults. Avoid dairy products and all beverages that contain water of questionable quality.
Antibiotics such as ciprofloxacin and norfloxacin are often 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 or Imodium, can decrease the number of diarrhoeal stools, however, as they work by slowing down the transit time of the gut's contents, they can cause complications for persons with serious infections by delaying the clearance of the infectious agent which the body tries to expel via the diarrhoea. They should never be used if a person has a fever or bloody diarrhoea.
When to see a doctor
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. It is a useful precaution to take some rehydration sachets, such as Gastrolyte, in your holiday medical kit.
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; or
- a pregnant woman or someone who has a long-term medical condition such as heart disease develops diarrhoea.
Adult travellers should seek medical help if diarrhoea does not resolve within a few days, or if it is bloody and accompanied by fever or chills, or if they are unable to keep fluid intake up and become dehydrated.
Last Reviewed: 10 March 2004
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