Travellers' Diarrhoea

Travellers' diarrhoea (TD) is an illness typically caused by the ingestion of bacteria, parasites, or viruses through water or food. It affects the digestive tract, commonly causing abdominal cramps, vomiting, and diarrhoea (watery loose stools). Travellers' diarrhoea affects 30-70% of all international travellers. Most cases of TD usually clear up by themselves; if symptoms persist, a course of antibiotics will be prescribed. 

What is Travellers' Diarrhoea 

Traveller's diarrhoea is a gastrointestinal infection that affects travellers and others when contaminated food or water is consumed. It most commonly causes abdominal cramps and watery loose stools (diarrhoea). Usually, TD is not very serious and clears up by itself in a couple of days. 

Travellers' diarrhoea (TD) is the most common travel-related illness affecting between 30-70% of travellers. When you consume contaminated water or food, your immune system picks up that there is an infection in your gastrointestinal tract. Your immune system then triggers an inflammatory response to kill and remove the pathogen. The inflammatory response causes the uncomfortable symptoms of infection associated with travellers’ diarrhoea. 

What causes Travellers' Diarrhoea

Travellers' diarrhoea most often affects those travelling to tropical countries. People from developed countries, such as the U.S, and Europe, who have never visited developing countries are most likely to develop travellers' diarrhoea. The most common causative agent of TD is bacteria, especially E.coli.  

Travellers' diarrhoea is caused by a bacterial infection (in 80% of cases) from ingesting contaminated water or food. Contaminated food results from poor food hygiene, which usually affects seafood, undercooked or raw meat, and raw vegetables and fruit. Tap water, ice, and liquid dairy products are also common causes of travellers’ diarrhoea. 

Other common bacteria that cause travellers’ diarrhoea:

• Shigella
• Salmonella 
• Campylobacter jejuni
• Cholera 

Parasites that may cause travellers' diarrhoea include: 

• Cyclospora 
• Giardia 
• Cryptosporidium

Viruses that may cause travellers’ diarrhoea include: 

• Astrovirus 
• Norovirus
• Rotavirus

Diagnosis

In most cases, a description of recent or current travels and your symptoms are enough for your healthcare provider to diagnose travellers’ diarrhoea. In some cases, your doctor may request a stool sample to find the exact cause of your infection. This can help your doctor determine the best treatment option, especially if they suspect a parasite that is not treatable with antibiotics.

Treatment 

Minor cases of travellers’ diarrhoea can be treated with over-the-medicine such as Imodium (loperamide) and Dioralyte, a rehydration sachet. Imodium works to ease the symptoms of TD, while Dioralyte replaces lost fluid and electrolytes. Even with mild symptoms, it is important to drink plenty of fluids to avoid dehydration. 

For more severe cases (persist for more than 48hrs), antibiotics may be prescribed by a doctor to treat the infection. Common antibiotics prescribed for travellers’ diarrhoea include azithromycin, ciprofloxacin, or rifampicin. These antibiotics are short-course antibiotics that kill the bacteria causing the infection. In most cases, the infection is resolved within 48-72 hours. 

Imodium and Dioralyte are usually recommended in conjunction with antibiotics to help ease symptoms and provide rehydration while the antibiotics start to work. Adults can take 2 Imodium tablets alongside the antibiotics to stop the diarrhoea, and a further 1 Imodium tablet every time you pass a watery stool until it stops. Adults can take a maximum of 8 Imodium tablets a day. 

1 Dioralyte sachet mixed with 200ml clean water should be taken with every loose stool movement. You can take up to 5 sachets a day.

When travelling internationally, a few essential items to carry with you include: 

• An antibiotic (Xifaxanta, Ciprofloxacin, Azithromycin)
• Iodine or chlorine tablets to purify water
• Rehydration sachets 
• Hand sanitiser lotion or gel
• Anti-diarrheal medication (Imodium or loperamide)

Can I reduce my risk of getting Travellers’ Diarrhoea? 

When travelling, the best preventative measure is practising good hygiene. This will help reduce or prevent the spread of the bacteria or pathogen that causes diarrhoea. While there is no guarantee that these preventative measures will prevent you from contracting TD, they can reduce your risk. Other preventative measures include:

• Avoid swimming in contaminated water. 
• Do not swallow any shower water.
• Wash your hands frequently, especially after using the bathroom and before eating. 
• Brush your teeth with boiled or bottled water. 
• Stick to bottled or canned beverages.
• Keep children from sitting or crawling on the ground. 
• Carry an alcohol-based sanitiser (lotion or gel) to clean your hands. 
• Stay away from fresh produce unless you can peel it yourself. 
• Avoid sharing towels, cutlery, utensils, and flannels with other people. 
• If you have diarrhoea, it is recommended not to part take in group activities for at least 48 hours after your last loose stool. 

As a precaution, taking at least some Imodium and Dioralyte with you is recommended when travelling abroad.