Everything you should know about traveller’s diarrhoea before going on vacation

What is traveller’s diarrhoea?

Traveller’s diarrhoea is defined as three or more loose or watery stools within 24 hours, and frequently, the condition is followed by symptoms such as stomach cramps, fever, nausea, vomiting and/or bloody stools. Mild to moderate diarrhoea is defined as one to two loose stools per day with no additional symptoms. Traveller’s diarrhoea often develops around six to seven days after arriving at the destination, and often the condition will disappear on its own within three to four days without the need for treatment. Many of those who get traveller’s diarrhoea, however, end up changing their plans or cancelling the trip because the pain is unbearable.

What are the causes of traveller’s diarrhoea?

Several pathogenic microorganisms cause traveller’s diarrhoea. It depends on travel destination, the time of year and environment. The most common cause is bacteria – these cause around 80% of all cases. The most common types of bacteria include E. Coli – especially the Enterotoxigenic E. coli (ETEC) and Campylobacter. In more rare cases, a virus is the cause, but if this is the case, it will often be due to infection with Rota- or Noroviruses. If the condition occurs suddenly after a meal, it is very likely that you have ingested a toxin from a bacterium, even if the bacterium itself is not present.

How do I prevent traveller’s diarrhoea?

To prevent traveller’s diarrhoea, it is a good idea to follow the following advices:

Always wash your hands thoroughly before cooking and eating meals – preferably using soap and water and alternatively hand sanitizers containing at least 60% alcohol.
In addition to washing hands, common sense is important when choosing meals and beverages: Choose food that has been adequately heated and avoid tap water, cold sauces and dressings, and cooked food that is left out at room temperature as well as food from markets.
Prebiotics, probiotics, and synbiotics in general are not recommended to prevent traveller’s diarrhoea, as no studies suggest that these reduce the risk of getting traveller’s diarrhoea. The supplements are, however, not harmful.
Being vaccinated with Dukoral against cholera is generally not recommended unless there is a risk of cholera at the destination.
Consider vaccinating infants against Rotavirus if you plan to stay in a developing country for an extended period of time.
Antibiotic prophylaxis is generally not recommended. Doing so could increase the risk of being infected with antibiotic-resistant bacteria, which are far more dangerous than those that typically cause diarrhoea.

What do I do if I get traveller’s diarrhoea?

When travelling, it can often seem problematic to find a foreign doctor to treat you, and most people therefore choose to do it themselves. Medical treatment in foreign countries might also involve the risk of being infected with other diseases, caused by things such as contaminated needles. Therefore, knowing how to treat traveller’s diarrhoea is beneficial. The most important thing is to avoid dehydration. Furthermore, it is beneficial if you are able to alleviate symptoms, reduce the course of the disease and avoid altering or ending the vacation. And remember: Traveller’s diarrhoea is self-limiting, often uncomplicated and brief.

Fluids and electrolyte treatment: This is the most important aspect of treating traveller’s diarrhoea – especially in children and elderly people. You can use ‘Oral Rehydration Solution’ (ORS) or another rehydration solution. In adults, drinking 2,500 ml of fluids per day plus an additional 200 ml per stool combined with carbs and salt will often be adequate. An effective rehydration drink you can make at home consists of 1 litre of boiled water mixed with 8 teaspoons of sugar, 1 teaspoon of salt and the juice of two oranges.
Obstipation: Loperamide, which slows down the activity of your bowel, should only be used by adults and children above the age of six and should be taken for a maximum of two days. In severe cases, including bloody diarrhoea and fever, it should not be taken separately but only along with antibiotics. This alleviates symptoms and reduces the duration of the disease.
Antibiotics: This can be used to treat severe cases of diarrhoea if the bacterium is sensitive to antibiotics. On average, the duration of the disease is reduced from three days to a day and a half. Often azithromycin or ciprofloxacin are used to treat traveller’s diarrhoea. However, there is a risk of being infected with multiresistant bacteria causing more severe diseases which can be difficult to treat, contrary to self-limiting traveller’s diarrhoea. If you experience a high fever (38.5 degrees or more) for more than a few days, diarrhoea for more than two weeks and/or bloody stools, it is important to seek medical help.

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