Travellers Diarrhoea
The most common sources of Travellers Diarrhoea are from eating contaminated food or drinking unfit water.
Travellers Diarrhoea (TD) is an exhausting condition that arises commonly form a parasitic infection. The most common sources of infection are from eating contaminated food or drinking unfit water.
In the UK there are high standards of hygiene which are managed and overseen by law. In other countries the standards may be different and not as well followed. In these situations, the traveller needs to be taking additional steps to reduce the risk of infection.
Some of the additional steps can be the additional vaccines such as hepatitis A, typhoid, polio and cholera which are food or water infections. Unfortunately, there are no vaccines against some of the other common infections and the traveller needs to be adding extra protection by increasing hand washing or using antiseptic gels; avoiding raw fruits and vegetables (unless they can be peeled) as they may be washed in local tap water, eating hot freshly cooked food.
These infections also apply to water. It is not uncommon in some countries to have fake or counterfeit water in bottles. This is where disposed plastic bottles are refilled with local tap water, added a new cap and label, then re-sold. The standards of water in water are not necessarily the same as UK bottled water. A study in 2017 showed that 66% of bottled water abroad had some form of infection.
Many regular travellers purify their own water by using methods such as boiling and cooling local tap water and then refilling reusable water bottles. Others use water purifying tablets or better still consider the using reusage water bottles (such as Aquapure) with filters that remove infections and can be refilled from local water.
Even when taking precautions on occasion an infection does occur leading to the symptoms and signs of TD. These can be treated by the use of rehydration salts dissolved in water and the purchase of preparations containing loperamide for example.
In circumstances where the frequency of the diarrhoea starts to interfere with the planned or daily routines then a stand-by antibiotic can be considered. The antibiotic of choice is azithromycin and is supported in its use by the International Society of Travel Medicine and can be considered when the diarrhoea is incapacitating or prevents planned activities.
The supply of this antibiotic can be provided by CityDoc on a named patient basis only following a detailed assessment of the intended trip and associated risks. You can also purchase Travellers Diarrhoea Kits can be purchased in our Flagship clinics for £35. These include all three treatments listed above; oral rehydration solution, Azithromycin (an antibiotic) and Loperamide (anti-motility).
Written by Derek Evans FFTM RCPS(Glasgow), FISTM, FRPharmS, FRGS
Travel Health and Vaccination Lead
