Traveller’s diarrhoea
Myths, realities, prevention, vaccines, and when to seek hospital care
What is traveller’s diarrhoea?
Diarrhoea acquired during/after travel, commonly due to ETEC and other bacteria; sometimes parasites. Most cases are self-limited.
Common myths — and the reality
- Myth: always needs antibiotics. Reality: most improve with hydration; antibiotics reserved for moderate–severe illness.
- Myth: alcohol kills germs. Reality: not reliable.
- Myth: bottled water always safe. Reality: ice, unsealed bottles, tops can contaminate.
Prevention strategies
Food and water precautions
- Hot, freshly cooked foods
- Avoid raw/undercooked meats/seafood
- Avoid unpasteurised dairy
- Peel fruit yourself
- Avoid questionable hygiene settings
Hand hygiene
- Soap and water
- Alcohol hand sanitiser when needed
Vaccines to consider before travel
- Hepatitis A
- Typhoid
- Cholera (selected cases; partial ETEC protection)
Managing traveller’s diarrhoea
- Use ORS early and consistently
- Antiemetics (e.g. ondansetron wafers) if vomiting prevents hydration
Anti-diarrhoeal agents
Loperamide may be used only if no fever and no blood.
When antibiotics are appropriate
Consider for moderate–severe illness, incapacitating symptoms, fever or dysentery. Preferred options depend on region: azithromycin often first-line; rifaximin for non-invasive illness only.
When to seek medical care while travelling
- Blood in stool
- High fever
- Severe abdominal pain
- Signs of dehydration
- Persistent vomiting
- Not improving after 48–72 hours
After returning home
Persistent diarrhoea (>14 days) warrants evaluation for parasites or post-infectious dysfunction. Avoid repeated empiric antibiotics.
Key takeaway: Traveller’s diarrhoea is common and usually self-limited. Hydration is first-line; antibiotics reserved for severe illness.