Traveller's Diarrhoea

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Traveller's Diarrhoea

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Before you start an assessment, please read all of the information below.

Traveller's diarrhoea is most commonly caused by food or water contaminated with bacteria. It can also sometimes be caused by viruses or parasites.

The highest risk areas include the Middle East, Africa, Central/ South America and Asia. 

Symptoms typically last 3 to 4 days, generally settle of their own accord and tend to be mild. Usually, antibiotics are not necessary but may be beneficial in certain circumstances. We can provide the antibiotic Ciprofloxacin as a standby treatment for Traveller's Diarrhoea to take with you before you travel. If however, you already have symptoms of diarrhoea then you will need to see a doctor. 

Please see Common Treatments below for further information.

The risk of developing traveller's diarrhoea is dependent on the area you are travelling to:

High-risk: most parts of Asia, Central and South America, Africa and the Middle East.

Medium-risk: Southern Europe, Israel, Russia, some parts of the Caribbean and the Pacific Islands, South Africa.

Low-risk: North America, Western Europe, Australia, New Zealand and Japan

There are regional differences in the risk of traveller's diarrhoea and estimates of incidence rates vary in different studies.


Common Symptoms

  • diarrhoea during, or shortly after a journey abroad
  • a fever
  • nausea (feeling sick)
  • vomiting
  • abdominal cramps
Common Treatments

Most episodes of travellers' diarrhoea are mild and self-limiting, and last around 3–4 days. Consider purchasing sachets of oral rehydration salts before travelling. Treatment with loperamide or Pepto-Bismol® may be considered for adults to relieve mild-to-moderate diarrhoea. Please consult a pharmacist about the suitability of these treatment options for you. You must not use them if you have blood or mucous in the stool and/or high fever or severe abdominal pain, and you should seek medical attention if you develop any of those symptoms.

Possible stand-by antibiotic treatment we may prescribe if clinically appropriate:

*Prices shown are cost price of the medication, taken from the British National Formulary 2018, and are given as a guideline. Pharmacies will add a dispensing fee to this which will vary considerably, so it is worthwhile phoning around to compare prices. The medication is paid for at your chosen pharmacy. 

Please click on the medication above to read the Patient Information Leaflet for important information about the drug. We use national prescribing guidelines to select which treatment would be most appropriate for your condition. 

Preventative Measures

Certain measures may help reduce the chances of developing traveller's diarrhoea:

Hand washing

  • after using the toilet, before eating and before preparing any food

Antibacterial hand gel

  • to use when water and soap are not available

If travelling to an area with poor sanitation then avoid:

  • tap water
  • ice cubes
  • ice-cream
  • street food
  • raw seafood and shellfish
  • salads
  • eggs
  • undercooked meat
  • mayonnaise
  • unpasteurised milk
  • peeled/prepared fruit
Self-Help for Symptoms

The following advice may help with your symptoms: 

Replace lost fluids

  • Drink at least 200ml of safe drinking water after each diarrhoea in addition to what you would normally drink (which should be 1.5-2 litres daily).
  • You can use rehydration salts if available as they help improve the water to be absorbed by the body.
  • If vomiting then take small sips every few minutes.

Drinks to avoid

  • Alcohol and other drinks and beverages with a diuretic effect (such as coffee and tea) should be avoided.

Food

  • eat small light meals if you can.

Anti-diarrhoea medication (Loperamide)

  • Do not use if you have a fever or blood in your stool.
  • Do not use for longer than two days.
  • The medication works by slowing down your gut's activity. It may be used if necessary, and if your symptoms are mild.

Probiotics

  • may help traveller's diarrhoea and may shorten an attack by about one day.
Stand-By Antibiotic Treatment

If you are travelling to an at-risk area then we may be able to prescribe you the antibiotic Ciprofloxacin to take with you, just in case you develop significant symptoms of traveller's diarrhoea. 

However, the antibiotic should not replace you seeking medical advice where necessary. If your symptoms are worsening, not improving, or if you feel very unwell then you are advised to seek urgent medical attention.

Information about Ciprofloxacin

The antibiotic Ciprofloxacin can be prescribed as 'standby treatment' to take with you, just in case you develop significant symptoms of traveller's diarrhoea. 

Ciprofloxacin should be started if your bowel movements become:

  • very frequent
  • very watery
  • contain blood
  • last beyond three days

However, the antibiotic should not replace seeking medical advice where necessary. If your symptoms are worsening, not improving, or you feel very unwell then you are advised to seek urgent medical attention. 

Before you start the treatment, please read the manufacturers leaflet contained with the medication. This contains more information and lists all the potential side effects.

How to take the medication

The dose is 500mg to be taken twice a day for three days; it is important that you space out the doses evenly during the day, ideally by 12 hours. Swallow the tablet with water, and you can take it either before or after your meals.

Avoid milk, orange juice, antacids or vitamin supplements containing iron or zinc, during the two hours before, and the two hours after you have taken a dose of Ciprofloxacin. This is because they interfere with the absorption of Ciprofloxacin and will reduce the effectiveness of your treatment.

Driving 

Ensure your reactions are normal before you drive and before you use tools or machines as Ciprofloxacin may make you feel lightheaded or impair your concentration.

Complete the course

Keep taking Ciprofloxacin until the full course is finished (unless a doctor tells you to stop), even if you feel that the infection has cleared up. This is to stop the infection from coming back. If you forget to take a dose,  then take one as soon as you remember unless it's nearly time for your next dose. In this case, just leave out the missed dose and take your next dose as normal.

This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

Possible side effects to Ciprofloxacin

Most types of medicines can cause potential side effects. However, not everyone will experience them. The side effects often improve as your body adjusts to the new medicine, but if any of them continue or become troublesome then contact us, or speak with your doctor or pharmacist. 

  • Your skin may become more sensitive to sunlight than normal while on treatment. Use a sunscreen, particularly if you are exposed to intense sunlight for a prolonged period and avoid sunbeds.
  • Nausea

There are some rare but more serious side-effects which have been associated with ciprofloxacin. If you experience any of the following then speak with your doctor as soon as possible:

  • An allergic-type reaction, such as swelling around your face or mouth, a skin rash, or any difficulty breathing.
  • Joint pain or swelling
  • Visual or eye problems
Allergic reactions to medication

An itchy rash, swollen face or mouth, or difficulty in breathing, may be signs that you are allergic to the medication. 

Please note that i-GP DOES NOT TREAT Medical Emergencies. 

If you develop a sudden onset of any of the symptoms below then you must STOP the medication immediately and seek urgent medical advice. This could be from your GP, Out of Hours Service, Urgent Care Centre or NHS 111. Call an ambulance or go to A&E if the symptoms are severe.

  • Wheeze
  • Difficulty in Breathing
  • Swelling of the eyelids, face or lips
  • A rash particularly if affecting your entire body
Antibiotic Guardianship

Antibiotics should be used responsibly and only when really necessary. Overuse and misuse of antibiotics can lead to antibiotic resistance. This is where the antibiotic becomes less effective at treating certain types of bacterial infection, so they do not work when needed. 

Antibiotics should be taken as prescribed, and it is important to complete the full course, this can reduce the chance of the bacteria developing an immunity to that antibiotic. It is important not to share antibiotics, and always take unused medication to your local pharmacy for disposal.

References

NICE Clinical Knowledge Summaries: Diarrhoea - prevention and advice for travellers. 

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