Travellers’ diarrhoea

Travellers’ diarrhoea is a clinical syndrome resulting from
microbial contamination of ingested food and water.

DESCRIPTION

Travellers’ diarrhoea is the most common ailment affecting
overseas travellers. The ailment has many names, including Delhi
belly, Bali belly, Montezuma’s revenge and Pharaoh’s curse,
depending on what country is being visited. Take special care in
the developing areas of Africa, the Pacific Islands, southern Asia,
the Middle East and Central and South America.

Travellers’ diarrhoea is usually defined as the passage of 3 or
more loose stools over a 24-hour period, or any number of loose
stools if accompanied by abdominal pain, fever, nausea or vomiting.
There may also be fever and muscle aches and pains. Travellers’
diarrhoea is usually self-limiting, lasting three to four days but
around 3 percent of cases persists for longer than a month. The
problem is usually caused by bacteria found in the local water
supply. Travellers may avoid drinking water from the local supply
but become infected with Travellers’ diarrhoea by brushing their
teeth using local water, using ice made from local water or eating
foods prepared using local water. Symptoms can begin 12 to 72 hours
after consuming contaminated food or water.

TREATMENT OPTIONS

• Ask your Doctor for advice about what medications to take with
  you overseas.
• The key to managing Travellers’ diarrhoea is to prevent
  dehydration and loss of body salts. Travellers should replace lost
  body fluids with an oral rehydration solution dissolved in drinking
  clean water. Oral rehydration solutions contains precise amounts of
  electrolytes found in the body fluids.
• People with Travellers’ diarrhoea should rest and stay indoors
  during hot weather, eat food that can be tolerated, wash their
  hands frequently, particularly after going to the toilet and avoid
  foods that could worsen their condition. Foods that may irritate
  the sensitive lining of the intestines in Travellers’ diarrhoea
  include milk, milk products, high-fibre foods, spicy foods and raw
  foods (e.g. uncooked vegetables).
• Seek medical advice if you are experiencing any of the
  following symptoms: blood or mucus in the stools; more than five or
  six bowel actions in 24 hours; abdominal pain and tenderness;
  persistent vomiting; fever; no improvement within a few days;
  dehydration or if you are suffering another medical condition,
  particularly one that requires medication. If you are experiencing
  these symptoms, do not take antidiarrhoeal medications.
• If you have Diarrhoea and cannot break travel commitments (e.g.
  you have a plane to catch), you may consider taking antidiarrhoeal
  medication. However, you should only take antidiarrhoeal medication
  if the diarrhoea is mild and is not accompanied by blood or mucus
  in the bowel movement, severe abdominal pain or high fever.
  Antidiarrhoeals can prolong infection or cause constipation.
  Children should not be given antidiarrhoeal medication.

 

Antibiotics are generally not recommended for mild diarrhoea.
However, they might be considered for those travellers that have a
serious underlying medical condition or whose travel plans would be
severely disrupted by illness, e.g. business travellers and
athletes.

PREVENTION

You can minimise the risk of developing Travellers’ diarrhoea
by taking simple precautions while overseas. 

• Drink only boiled or sealed bottled water. Be aware that some
  vendors sell ‘counterfeit’ bottled water, so be vigilant.
• You can purify water with a special chemical solution
  containing iodine. Always follow the instructions very carefully
  when using these solutions to disinfect water. Do not use these
  solutions if you are pregnant or have thyroid disease. 
• Avoid adding ice to drinks. 
• Adding alcohol to drinks will NOT “sterilise” bacteria.
• Only eat food which is piping hot and which has been cooked
  well. Avoid buffets and pre-prepared food.
• If in any doubt about refrigeration, avoid non-pasteurised
  dairy products.
• Avoid salads and raw vegetables.
• Only eat fruit that still has the peel intact and always peel
  the skin off fruit before eating.
• Avoid raw fish and shellfish as these may have been living in
  contaminated water.
• Avoid uncooked or cold street-stall food.
• Clean your teeth using bottled water.
• Wash your hands thoroughly after using the toilet and before
  eating.

• People who need a regular intake of food, such as those with
  diabetes, should look for a suitable eating place as soon as
  possible after arriving at a destination. 

See the Water Purification topic on the Healthpoint.

PHARMACIST’S ADVICE

Ask your Pharmacist for advice before any travel.

1. Ask your Pharmacist for some anti-diarrhoea tablets to take as
   a precaution. If you have Diarrhoea, only take the tablets when
   your temperature is normal (37 degrees C/98.6 degrees F) and there
   is no blood or mucus in the stools. Do not take these tablets for
   longer than 48 hours and seek medical attention.
2. Ask your Pharmacist for advice about medication that may help
   to reduce the risk of Travellers’ diarrhoea.
3. If you are going to a known contaminated area, drink only
   fluids that you are certain have been properly sterilised (e.g.
   only drink from a container with a sealed lid that has not been
   tampered with).
4. If you intend to drink the local water, ask your Pharmacist to
   recommend a water purification method such as iodine tablets. See
   the Water Purification topic.Remember to drink fluid if you do have
   an attack of Diarrhoea in a foreign destination. Ask your
   Pharmacist about an oral rehydration solution (electrolyte powder)
   to take with you. Adding this to your drinks can help to prevent
   dehydration.
5. Acidophilus is a live culture that may help to restore the
   patient’s normal balance of gut flora which may have been disturbed
   by an infection which has caused Diarrhoea. Acidophilus is
   available from your Pharmacy in capsule or powdered form. It is
   best to purchase fresh, refrigerated acidophilus when you return
   from travelling, as the live culture is sensitive to heat.