Travellers’ diarrhoea treatment

Travellers’ diarrhoea refers to the gastrointestinal illness you can sometimes get when travelling, which includes diarrhoea. It’s a really common condition, affecting between 40 and 60% of travellers.

Most commonly, people get travellers’ diarrhoea in the first few weeks of travelling to a new place as their body gets used to the new environment and bugs that live there, but it can happen at any point during your trip.

Travellers’ diarrhoea is spread through contaminated food and water, but also from person to person. It’s more common in countries where hygiene standards are lower than you’re used to at home.

There’s not just one bug that’s responsible for travellers’ diarrhoea – a variety of viruses, bacteria, and other parasites can cause you to develop symptoms.

Alongside loose or fully liquid stools, travellers’ diarrhoea may cause:

• stomach cramping
• fever
• feeling sick (nausea)
• being sick (vomiting)
• blood in your diarrhoea

Although it can be normal for your toilet habits to change slightly when travelling, if you’re having 3 or more loose stools a day, especially in a less economically developed country, then this is classed as travellers’ diarrhoea.

Most of the time, symptoms last for between 3 and 5 days and get better by themselves. In some cases, you may need medication or an assessment from a healthcare professional, especially if your symptoms are severe, you feel unwell or you have pre-existing health conditions.

When your diarrhoea symptoms are disrupting your day but your symptoms are not severe, you may choose to take a travellers’ diarrhoea medication such as loperamide or antibiotics.

Treatment can help reduce how often you’re going to the toilet, help with some of the cramping pain, and speed up how long the infection lasts.

If your symptoms get worse, you may need advice from a doctor. Seek medical advice if you:

• cannot continue your normal activities and have had more than 6 episodes of diarrhoea in the last 24 hours
• there’s blood or mucus in your diarrhoea
• keep being sick
• have a fever
• have severe stomach pain
• have symptoms that don’t improve within 3 days
• are pregnant
• are elderly
• have pre-existing health conditions

If your diarrhoea does not happen often and is not disrupting your normal activities too much, there’s no need for treatment. Stay hydrated and rest if needed.

Clear fluids or oral rehydration salts, like Dioralyte, can help keep you hydrated. Make sure all the water you drink is clean and treated to a high standard to avoid picking up any more bugs.

Travellers’ diarrhoea treatment usually consists of antibiotics that help to kill the bacteria causing the infection, or anti-diarrhoea tablets that slow down the gut movements.

Antibiotics

Antibiotics work to treat travellers' diarrhoea by killing or inhibiting the bacteria causing the infection. They clear the infection faster, reduce the severity of symptoms and prevent complications in more severe cases.

Azithromycin is a macrolide antibiotic used to treat bacterial infections, such as travellers’ diarrhoea. It works by containing the infection, which means the infection cannot spread, and your body’s immune system can fight it off.

Ciprofloxacin is another broad-spectrum antibiotic that was previously used to treat travellers’ diarrhoea. This is no longer recommended because of high levels of resistance to this particular antibiotic.

Anti-diarrhoea tablets

Anti-diarrhoea tablets, such as loperamide, work by slowing down muscle movements in the gut. This means that a greater amount of water is absorbed from the stools, so the stools are less loose and passed less frequently. It’s not an antibiotic and may not always be recommended for travellers’ diarrhoea, especially if it’s caused by bacteria.

How effective is travellers’ diarrhoea treatment?

In studies, azithromycin was found to be effective in reducing the severity and duration of travellers’ diarrhoea.

In other studies, antibiotics were found to shorten the average time of symptoms from 3 to 1.5 days.

How long does it take for travellers’ diarrhoea treatment to work?

It can take a few days for travellers’ diarrhoea treatment to work. Antibiotics are usually taken for 3 days.

Loperamide and other anti-diarrhoea medications tend to improve symptoms after a few hours, but are only a temporary solution.

Can travellers’ diarrhoea come back after treatment?

Yes, if you are still travelling, it’s possible to pick up a different bug and suffer from travellers’ diarrhoea again. Some people also have diarrhoea after taking antibiotics.

Travellers’ diarrhoea treatments include oral rehydration salts, anti-diarrhoea medications, and antibiotics.

Antibiotics

Azithromycin can reduce how long travellers’ diarrhoea lasts because it helps your body fight off the infection. If prescribed for you, you should start azithromycin at the first signs of travellers’ diarrhoea, and keep taking it for as long as your doctor advises. The usual treatment course is 3 days, but how many tablets you take each day depends on the severity of your symptoms.

Travellers’ diarrhoea is an ‘off-label’ use of azithromycin. This means using a medication for another condition that it can help with, under the supervision of a doctor.

Oral rehydration salts

Rehydration salts, like Dioralyte, come in a sachet and can be added to fresh, clean water. They contain extra electrolytes that can be lost when you have diarrhoea and help keep you hydrated.

Anti-motility (anti-diarrhoea) medications

Medications like loperamide or bismuth subsalicylate are useful for temporarily stopping your symptoms if you’re in a situation where you're unable to go to the toilet as much as you need to.

They slow down the movement of your gut, which can help with the cramping pain and reduce how often you need to go to the toilet, but they are only a temporary solution and can cause constipation.

You should only use these types of medication for 2 days, and should avoid them if you have a fever or if blood or mucus is present in your stools.

What’s the best treatment for travellers’ diarrhoea?

The best way to treat mild travellers’ diarrhoea is to stay hydrated. This keeps your body healthy and allows it to fight off the cause by itself.

Whether you need additional treatment will depend on how severe your symptoms are and what the cause of your travellers’ diarrhoea is – antibiotics will not work if your diarrhoea is caused by a virus.

Always take medication as instructed on the medication packaging unless otherwise advised by a healthcare professional.

Some medications for travellers’ diarrhoea can be bought over the counter in most pharmacies, but if you require antibiotics, you will need a prescription from a doctor before you can obtain them.

Can I buy travellers’ diarrhoea treatment online?

Yes, you can request certain travellers’ diarrhoea treatments online from ZAVA. We offer the antibiotic azithromycin off-license as a treatment for travellers’ diarrhoea.

Simply select your treatment, fill in the medical questionnaire, and our team of doctors will check whether the treatment is suitable for you. Your medication will then be shipped to your home or collection point.

Can I get travellers’ diarrhoea treatment over the counter?

Yes, you can purchase anti-motility medication and rehydration sachets from your local or online pharmacy, and you may be able to buy them from a pharmacy in your destination. It’s a good idea to buy these medications in advance and take them on your trip in your first aid kit, just in case you need them. Antibiotics cannot be purchased over the counter – you will need a prescription if you need them.

Can I get travellers’ diarrhoea treatment on the NHS?

No, travel medication is not covered on the NHS in most cases. If you have a specific medical condition, a doctor may prescribe you antibiotics to take to prevent or treat travellers’ diarrhoea, but this isn’t standard.

Side effects depend on which medication you’re taking.

It’s rare to experience any side effects when taking oral rehydration sachets, although, as with any medication, it’s possible to experience an allergic reaction.

Side effects of anti-motility medications like loperamide are usually mild and get better after stopping the medication. The common side effects include:

• headaches
• feeling sick
• constipation
• farting

Different antibiotics have different side effects, but the common side effects of azithromycin include:

• headaches
• dizziness
• sleepiness or tiredness
• changes in taste
• numbness or pins and needles
• changes in vision
• deafness
• being sick (vomiting)
• heartburn
• joint pain
• rashes
• itchy skin
• reduced blood cell count on blood tests

Most side effects improve after stopping the medication. If you experience any worrying side effects, contact a healthcare professional for advice or contact emergency services in a life-threatening situation, such as with a severe allergic reaction, severe stomach pain or feeling acutely unwell.

A full list of side effects can be found in the patient information leaflet contained within the specific medication you’re taking.

Travellers’ diarrhoea treatment may not be right for everyone - certain conditions or certain medications can interact with these treatments and make them less effective, or potentially unsafe.

Rehydration salts may not be suitable for people with phenylketonuria (PKU) or severe liver or kidney problems.

Anti-motility medication is not recommended for children. Loperamide should be avoided in children younger than 12, and bismuth subsalicylates under the age of 16.

Antibiotics should be avoided in people with a known allergy, and certain antibiotics should not be taken by children or pregnant women. Some antibiotics react with other medications, leading to a reaction or stopping one of the medications from working properly. Azithromycin should not be taken by people who have liver disease, higher risk of cardiac arrhythmias or myasthenia gravis.

Taking antibiotics unnecessarily can lead to bacterial resistance, so you should only take antibiotics when instructed to do so by a doctor.

It’s important to check with a medical professional whether it’s safe for you to take any medication, as the specifics of each medication are different. Always make sure to discuss any pre-existing health conditions you have or other medications you take with a doctor before taking travellers’ diarrhoea medications.