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What is Travellers' Diarrhoea?

Travellers' Diarrhoea is the main health problem for international travellers affecting over 50% of people. High risk destinations include most of South America, Africa, Asia and South East Asia. The symptoms are abdominal cramps, fever, diarrhoea and vomiting. In almost a third of cases, the symptoms will be severe enough to confine sufferers to bed. It can therefore seriously affect enjoyment of a holiday or effectiveness on a business trip.

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What are the causes of travellers' diarrhoea?

The most common causes of holiday or travellers' diarrhoea are the different types of virus and bacteria at the destination. The local drinking water in particular is an obvious source of risk in many places and should, therefore, be completely avoided. Replace it with water from previously unopened bottles for drinking, as well as for cleaning teeth and making ice for drinks.

Approximately 40 per cent of all cases of travellers' diarrhoea are due to infections with ETEC (enterotoxin-forming Escherichia coli bacteria). It is also possible to be infected with other, more specific and unpleasant bacteria and parasites, such as:

• cholera
• typhoid fever
• paratyphoid fever
• salmonella
• clostridia
• yersinia
• shigella
• bacillus cereus
• amoebae
• giardia lamblia

Such infections will typically require medical treatment and possibly antibiotics.

How common is travellers' diarrhoea?

The risk of suffering from diarrhoea is high, and estimates vary from 30 to 80 per cent of travellers. It rises among other things with the exotic nature of the destination, the climate (particularly in the tropics) and poor general and personal hygiene. But stomach infections can occur anywhere in the world, and unpleasant bacteria also flourish in the UK (for example salmonella, campylobacter and listeria).

Do I need to consult a doctor when suffering from travellers' diarrhoea?

The majority of cases will calm down within five to eight days and do not require any drug treatment. However you are strongly advised to seek medical help if you develop any of the following danger signals.

Bloody diarrhoea may be seen in several diseases, but on certain trips consideration must be given to the possibility of shigella dysentery and amoebic dysentery in particular. Shigella dysentery (bacillary dysentery) occurs quite suddenly and typically causes many (10-25) bloody episodes of diarrhoea a day, a high temperature, gastric pain, and pain on defaecation (tenesmus). The immediate danger is weight loss (through dehydration). The treatment will typically be a quinolone antibiotic, e.g. ciprofloxacin. Amoebic dysentery typically arises more slowly and is not associated with fever. It requires full treatment with metronidazole to exclude the possibility of late complications, such as liver disease.

High fever is seen in many infectious conditions and is not a danger signal in itself. But in places where more exotic infections are possible, including malaria, medical assistance should be sought in the case of a high fever or poor general condition.

Diarrhoea with yellowish or greenish mucus

Dehydration arising if the patient is unable to drink sufficiently, which may be apparent for example from dark and scant urine production, lethargy or even confusion, and dry mucous membranes (lips and tongue).

Acute diarrhoea in infants and young children, the elderly and anyone else who is already weak or ill.

Can I buy ciprofloxacin for travellers' diarrhoea?

Ciprofloxacin is a broad spectrum antibiotic which used to be used to treat bacterial causes of travellers' diarrhoea. This is no longer the recommended treatment course since March 2019. It is therefore no longer available for travellers' diarrhoea. You can find more information about this and the latest recommendations from NaTHNaC (the National Travel Health Network and Centre).