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Diarrhoea - prevention and advice for travellers - Management
What should I advise about managing traveller's diarrhoea while travelling?
- Advise the person that most episodes of traveller's diarrhoea are mild and self-limiting, lasting around 3–5 days.
- The person could consider purchasing sachets of oral rehydration salt before travelling — particularly for infants.
- During an episode of diarrhoea, fluid intake should be increased to prevent dehydration — this is particularly important for infants, young children, and elderly people.
- For infants, breastfeeding should not be interrupted.
- Hydration must be maintained, for example with oral rehydration salt solution and boiled, treated, or bottled water.
- Safe drinking water should be used to reconstitute oral rehydration salt sachets.
- Alcohol and other drinks and beverages with a diuretic effect (such as coffee and tea) should be avoided.
- Immediate medical attention is required if children show signs of dehydration; such as restlessness or irritability, great thirst, sunken eyes, and dry skin with reduced elasticity.
- Neither loperamide nor Pepto-Bismol® are recommended for children to relieve diarrhoeal symptoms.
- Loperamide should not be used in children younger than 12 years of age because of concerns that it may cause intestinal obstruction.
- Pepto-Bismol® contains salicylate and must not be used in children younger than 16 years of age because of the possible association between salicylates and Reye's syndrome.
- Both loperamide and Pepto-Bismol® may be considered in adults for relieving mild-to-moderate diarrhoea.
- They should be used for no longer than 1–2 days.
- Loperamide can be considered when rapid control of symptoms is required — for example during travelling where toilet amenities are limited or unavailable.
- Because of its salicylate content, Pepto-Bismol® is not suitable for people with aspirin allergy, renal insufficiency, gout, or who are taking an anticoagulant such as warfarin, as well as those at risk of gastrointestinal bleeding. Darkened tongue and stools are common adverse effects.
- Loperamide should be avoided if the person is feverish, or has bloody diarrhoea or acute ulcerative colitis, as it can inhibit peristalsis, resulting in complications such ileus, megacolon, and toxic megacolon.
- Certain medications may be affected by severe diarrhoea (for example the effectiveness of warfarin, anticonvulsants, and the oral contraceptive pill are reduced) or can exacerbate dehydration (for example diuretics).
- Medical assistance must be sought if:
- Stools are blood stained, or there is fever.
- The person becomes dehydrated — particularly in infants and children (restlessness or irritability, very thirsty, sunken eyes, and dry skin with reduced elasticity).
- It is difficult to maintain adequate hydration, because of frequent, watery stools, or repeated vomiting.
- Diarrhoea persists for more than 3 or 4 days.
- Diarrhoea does not respond within 3 days to empirical antibiotic treatment.
- Advice for travellers can be found on the following websites:
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