Traveller’s Diarrhoea
Common Pathogens
Enterotoxigenic E. coli (ETEC): Most common (50%)
Salmonella, Campylobacter, Shigella
Norovirus: Significant cause, especially on cruises or group travel
Parasites: Giardia (if symptoms persist >7 days, consider parasitic causes)
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Prophylaxis
Consider antibiotics (e.g., azithromycin) only for high-risk travellers (e.g., immunocompromised, IBD, critical travel for work)
Bismuth subsalicylate: 524 mg 4x/day can reduce diarrhoea risk by ~50% but avoid in renal failure and children due to salicylate risk
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Management
Non-Pharmacological
Hygiene: Wash hands frequently and use alcohol-based sanitisers
Diet: Freshly cooked food served hot; avoid ice, unpeeled fruits, and salads
Hydration: ORS (2–3 L over 24 hrs) to prevent dehydration
Precautions: Avoid loperamide if fever or bloody stools present
Pharmacological
Azithromycin: 1 g stat or 500 mg daily for 2–3 days (preferred in SE Asia due to fluoroquinolone resistance)
Alternative: Norfloxacin 400 mg daily (if resistance is not a concern)
Persistent diarrhoea (>7 days): Test for Giardia; treat with:
Tinidazole 2 g stat or Metronidazole 400 mg tds for 5–7 days
Severe Cases
Clostridioides difficile: Treat with Metronidazole 400 mg tds for 10–14 days
Empiric antibiotics not routinely recommended for mild self-limiting diarrhoea
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Preventative Advice
Avoid consuming water from unsealed sources; prefer bottled or boiled water
Avoid high-risk foods: undercooked meats, shellfish, and street food
Vaccinations (if relevant): Typhoid and cholera (limited efficacy for diarrhoea but useful in endemic areas)
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Differentials
Lactose intolerance: May worsen transiently post-infection
Post-infectious IBS: Common, particularly after Campylobacter or Salmonella infections
Coeliac disease: Persistent symptoms may warrant further investigation]
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