Questionnaire/history:

Passage of 3 or more loose-watery stools over a 24 hour period with symptoms starting during or after overseas travel?

Fever?

Nausea?

Vomiting?

Cramps?

Blood in the stool?

Causes:

Bacterial: most common cause: E. coli, Campylobacter, Salmonella, Shigella

Viral: Rotavirus, Norovirus

Parasitic: Giardia, Cryptosporidium, Entamoeba

Management:

Advised:

Good food, drink and personal hygiene

To consider prophylactic antibiotic treatment if:Immunocompromised

High risk of complications if they were to develop travellers' diarrhoea, for example:

- Chronic gastrointestinal disease (eg Crohn's disease or ulcerative colitis)

- Ileostomy or colostomy

- Other diseases (such as malignancy, type 1 diabetes mellitus, renal disease, stroke, congestive heart failure, or sickle cell disease) in whom a diarrhoeal illness might severely impact on their health

History of significant long-term morbidity after an enteric infection

Critical trips in which a short bout of diarrhoea could severely impact the purpose of the trip (for example athlete, politician, professional musician, lecturer)

Inadequate access to medical treatment if they experience complicated travellers' diarrhoea

Self-management advice given:

- Oral rehydration salts before travelling

During an episode of diarrhoea:

- For infants, breastfeeding should not be interrupted

- Hydration must be maintained, for example with boiled, treated, or sealed bottled water

- Most otherwise healthy adults can stay hydrated by eating and drinking as normal

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

- For more severe symptoms, or people prone to complications from dehydration, oral rehydration powders diluted into clean drinking water

- 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 elasticit

- Loperamide or bismuth subsalicylate (for example Pepto-Bismol®) may be considered for adults to relieve mild-to-moderate diarrhoea for a maximum of two days

(Note: Do not use loperamide or bismuth subsalicylate if blood or mucous in the stool and/or high fever or severe abdominal pain, neither loperamide nor bismuth subsalicylate recommended for children)

'Stand by' antibiotics if:

- Travelling to high-risk locations (especially where access to medical assistance is poor or not available, or there is doubt about the safety and purity of antibiotics available at their destination).

- At high risk of severe illness

Medical assistance must be sought if:

- Stools are blood-stained, profuse and watery, or there is high or persistent fever or severe abdominal pain.

- Severe diarrhoea in infants or elderly people, or a child is unwell with travellers' diarrhoea

- Dehydration: particularly in infants and children (restlessness or irritability, very thirsty, sunken eyes, and dry skin with reduced elasticity); or it is difficult to maintain adequate hydration

- Diarrhoea does not begin to improve within 24–36 hours despite self-treatment. 

- Comorbidity (for example immunosuppression or gastrointestinal disorder)

Resource(s):

BMJ 2016

CKS 2019

DTB 2013

National Travel Health Network and Centre “Yellow Book”