THE RISK

Travellers’ diarrhoea (TD) is the most common illness for travellers, particularly those visiting economically developing countries where food hygiene standards and personal hygiene facilities are poor.

Bacterial infections such a E.coli and Campylobacter are the most common cause of TD. These infections are easily contracted through contaminated food and water and person to person contact through poor personal hygiene. Contaminated money and faecal bacteria on banknotes abroad may also be a risk factor and good practice is not to handle it at the same time as food.

Due to a natural decline in immunity in older people, older travellers are more likely to experience TD than younger travellers and need to be prepared prior to travel to reduce and manage the risk of infection.

It is really important not to rely on healthcare abroad to manage Travellers’ diarrhoea as the risks of counterfeit medication, infection and poor medical care are high. For older adventure travellers it is important to be aware that supportive medical treatment may not be close by and that delay in treatment could significantly impact on health and safety.

Travellers’ diarrhoea can be a serious risk factor for older travellers who have pre-existing medical conditions including immune suppression. It can cause considerable fluid loss and dehydration particularly in very hot and humid climates. Dehydration has the potential to affect the absorption of important medicines increasing the risk of complications of well-maintained conditions and can worsen and complicate pre-existing medical conditions such as heart disease, diabetes and kidney impairment.

Prevention

Ways to help reduce the risk of Travellers’ diarrhoea :

  • Wash hands before handling food and after using the toilet.
  • Carry an antibacterial hand gel for emergencies.
  • Make sure plates, cups and other utensils are properly clean before using.
  • Drink bottled, boiled or purified water. Special bottles with filters are now available such as Water -to- Go bottles that eliminate viruses, bacteria and parasites. They are easy to use, effective and save plastic bottle wate.
  • Do not have ice cubes in drinks
    Avoid shellfish, raw and undercooked meat
  • Eat hot freshly cooked food and peelable fruit. Avoid salads.

Pre and Probiotics

There is ongoing research into the use of prebiotics and probiotics in the prevention of TD and that taking this supplement prior to and during travel may offer some protection by increasing friendly bacteria in the gut and supporting the gut’s natural defences. There are several products on the market such as Optibac – for travelling abroad which contains live cultures that support the gut microbiome.

Common Symptoms of Travellers’ Diarrhoea

Travellers’ diarrhoea is defined as three or more loose, watery stools sometimes with blood passed frequently within a 24-hour period, often accompanied by some of these symptoms; urgency to go to the toilet, abdominal bloating, cramps and pain. nausea, vomiting and stomach cramps, mild temperature and feeling weak.

Medical attention must be sought if symptoms do not improve by 3 days and if symptoms include a fever, blood or mucus in the diarrhoea, severe stomach pain, altered mental state or severe signs of dehydration such as thirst sunken eyes and dry skin. Dehydration can have severe consequences so it is important that medical care is sought with urgency.

Self Treatment

For the majority of Travellers, TD is generally self-limiting and short-lived only lasting a few days however hydration must be maintained during this time with boiled, filtered or bottled water (sealed). Alcohol should be avoided. It is also important to continue eating. A plain diet with foods such as bread, pasta, rice, potatoes and bananas can help keep the body nourished and hydrated.

ORAL REHYDRATION TREATMENT

Electrolyte powder sachets such as Dioralyte added to clean drinking water replaces essential electrolytes lost from the body through diarrhoea and helps to prevent dehydration. This oral rehydration treatment has a specific balance of sodium, potassium and sugar in the solution to help restore essential body water and salt. It should be taken soon as diarrhoea symptoms start, and after each episode.

LOPERAMIDE

Loperamide (known by many as Imodium) is an anti-motility drug that brings symptom relief by reducing the number of unformed stools. Some travellers believe that loperamide keeps the bacteria in the gut, prolonging the illness so they are reluctant to use it, however Loperamide actually increases absorption of fluids and electrolytes in the bowel to help maintain hydration and normalise intestinal transit times. If used correctly is an important medicine in the management of mild TD particularly in the older travel to reduce the risk of dehydration.

ANTIBIOTICS

Azithromycin, an antibiotic can be used for the self-treatment of moderate to severe symptoms of TD with distressing symptoms, abdominal cramping and or fever. This treatment is considered for travellers considered at high risk of severe illness from TD or who are travelling to high risk remote areas where access to medical care is extremely limited. A specialist travel health clinician will advise if this is a suitable standby treatment for you. This will be based on an individualised travel health risk assessment and thorough medical history.

Older travellers who may be recommended antibiotics of the self-treatment of TD include:

  • Long term travellers to countries with poor access to healthcare.
  • Those taking Proton Pump inhibiters such as Lansoprazole or Omeprazole.
  • Those with Inflammatory bowel diseases such as Crohn’s and Ulcerative colitis.
  • Those who are immunocompromised (taking immunosuppressive/ steroid medication).
  • Have diabetes.

With any medication or supplement, you must always seek medical advice to ensure it is safe and suitable for you to take.
Book an appointment and visit one of our Nomad Masta Travel Health clinicians. They will undertake an individual risk assessment and provide advice on appropriate treatment and management for Travellers’ diarrhoea.

References

https://travelhealthpro.org.uk/factsheet/53/travellers-diarrhoea

https://onlinelibrary.wiley.com/doi/full/10.1002/jmv.29312