Diarrhoea

Latest update: - Authors: Mieke Croughs, Ula Maniewski-Kelner

Traveller’s diarrhoea is the most common travel-related infectious disease. Diarrhoea is usually caused by eating or drinking food or water that has been contaminated with bacteria. Sometimes it is caused by a virus or parasite.

The symptoms of traveller’s diarrhoea consist of thin, watery stools that are passed three times a day or more often. Mild diarrhoea usually disappears without treatment within three to five days.

However, the following symptoms are signs of severe diarrhoea:

  • Blood or mucous in the stools
  • High fever > 38,5°C that lasts for more than one or two days
  • Severe abdominal cramps
  • Thin stools more than six times in 24 hours, particularly if this also occurs at night.

In warm countries, diarrhoea can quickly cause dehydration, particularly in children, elderly people and people with health problems.  

Risk areas

The risk of traveller’s diarrhoea is greatest in tropical and subtropical countries with a poor standard of hygiene.

Prevention

Food and drinks

The measures to ensure safe consumption of food and drinks will reduce the risk of diarrhoea.

ORS and diarrhoea inhibitor

ORS is an abbreviation for “oral rehydration solution”. It is a mixture of salt and sugar. Take ORS and anti-diarrhoea medication (loperamide or Tiorfix®) with you for the treatment of diarrhoea.

Antibiotics

In exceptional cases, your doctor will recommended that you take an antibiotic with you for emergency treatment.

Vaccination

There is no suitable vaccine for traveller’s diarrhoea yet.

In case of symptoms

You do not need to fast; eat foods that are easy to digest, divided into frequent, small meals.

Avoid dehydration

Drink plenty of purified water, tea with lemon, broth, soft drinks and fruit juice with salty crackers or crisps.

Also drink "oral rehydration solution" (ORS), a ready-made salt and sugar solution. ORS is sold under various brand names at the pharmacy. ORS is particularly important for people with a high risk of dehydration, such as elderly people and young children.  

Medication

Mild diarrhoea

  • Take anti-diarrhoea medication if necessary: 
    • Loperamide (e.g. Imodium®) 1 capsule or instant tablet of  after each loose bowel movement, up to a maximum of four times per day.
    • Stop taking this medication as soon as the stools become more solid, in order to avoid constipation.
    • Do not use for more than three days.
    • Do not use if you are pregnant or breastfeeding or in children younger than 6 years of age.
  • Or secretion inhibitor: Tiorfix®:
    • Adults 100 mg three times a day
    • Children of 3 months or older: 1,5 mg/kg per dosis, three times per day.  

Severe  diarrhoea

  • Do not use anti-diarrhoea medication.
  • Seek medical advice for the correct diagnosis.
  • You should seek urgent medical advice if you develop a fever, to rule out infections such as malaria. Use only paracetamol for the fever and not aspirin.
  • Call the travel assistance insurance during your trip for advice on reliable medical facilities. You can contact your general practitioner or a specialised clinic after returning home.
  • If medical assistance is not immediately available and you have been given an antibiotic to take on your journey , you can take it:
    • Azithromycin (e.g. Zitromax®): take 1000 mg at once, this is 2 tablets of 500 mg.
    • Azithromycin can be used during pregnancy and in children if the dose is adjusted.
    • Seek medical assistance if the symptoms do not improve within 48 hours.

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