Traveller's Diarrhoea

Diarrhoea is when you are passing stools more frequently than is normal for you or passing looser stools than usual. You can get diarrhoea as a result of stress or drinking too much caffeine or alcohol, but often it is caused by an infection in the bowel known as gastroenteritis. Gastroenteritis can be caused by a virus, bacteria or a parasite. It is very common for people travelling to other parts of the world, i.e. Asia, the Middle East, Africa and Latin America, to get bacterial or viral diarrhoea, also known as travellers’ diarrhoea. Normally, travellers' diarrhoea will go away by itself within about 3 days. In some cases, you might find it lasts for a week (particularly in children, who often take longer to bounce back). If the diarrhoea is frequent or severe, it can lead to dehydration, so you need to make sure you drink plenty of water.

Normally travellers' diarrhoea will pass by itself within about 3 to 7 days. About 10% of cases last for over a week and about 2% for more than a month, according to the British Medical Journal.

If you have diarrhoea, you can dehydrate quite quickly, especially if you're also vomiting, so you need to drink plenty of fluids to rehydrate. Taking small sips of water frequently can help. You can also take an oral rehydration solution – this is a sachet of powder that you dissolve in water and drink to replace salt, glucose and other minerals that are lost when your body is dehydrating. You can ask your pharmacist about this.

You need to be especially careful to avoid dehydration in children.

Medical opinion is divided over whether you should eat if you’ve got diarrhoea. Most specialists say that if you can eat and feel like eating, you should try to have a small light meal of solid foods. Avoid eating anything spicy or heavy. If you don’t feel like eating, you don't need to force yourself. Just drink plenty of fluids and start to eat when you feel up to it.

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

Please note traveller’s diarrhoea is an ‘off-label’ use of azithromycin.

All the medications that we offer are fully licensed within the UK. Some medications, like this one, we prescribe for conditions or circumstances that are outside of the licence (also known as ‘off-label’). Prescribing ‘off-label’ is common practice by healthcare professionals to ensure a medication can safely benefit as many patients as possible. This is always based on updated information and evidence since the product first became available.

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

Loperamide works 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.

Travellers’ diarrhoea is the most common health problem that travellers get. The National Institute for Health and Care Excellence (NICE) estimate that between 20% and 90% of people who travel for up to 2 weeks to low- or middle-income countries will get travellers’ diarrhoea.

Symptoms may vary depending on the severity of the diarrhoea. If you have mild diarrhoea, you might have a slightly upset stomach for a short while, with stools that are a bit watery. If you have more severe diarrhoea, you might have very watery stools over a prolonged period of time.

If you’ve got diarrhoea that's caused by a bacterial infection, you might also have:

• a fever
• headache
• stomach cramps
• loss of appetite
• nausea (feeling sick) or vomiting

Usually, severe travellers' diarrhoea is caused by bacterial and viral infections. The season can affect the risk – you are more likely to pick up diarrhoea caused by bacteria in the rainy season (or diarrhoea caused by a virus in the dry season). The type of travel also influences this – camping and backpacking put you at a higher risk than business travel.

You also can pick up a viral infection by direct contact, so you need to wash your hands regularly to prevent it (especially after going to the bathroom, before you eat, after coming into contact with animals, or after contact with another person who has diarrhoea.) If you can’t wash your hands with soap and water, use a hand sanitiser.

You can also catch bacterial diarrhoea by eating contaminated food or drinking contaminated water. Bacterial diarrhoea is often severe and comes with cramps, headache, fever and loss of appetite, as well as nausea and vomiting. There are several things you can do to prevent getting it:

Drink bottled or sterilised water (use this for everything you might eat or drink, e.g. to wash fruit, clean your teeth or make ice). Don’t eat salads (the ingredients may have been washed in contaminated water).

Be careful if you eat dairy products, as they may be unpasteurised.

Only eat food that is piping hot and hasn’t been left out at room temperature. Hot food should have been kept hot and cold food should have been kept cold.

Don’t eat raw egg.

Cook carefully. Wash all vegetables and fruit. Separate cooked and uncooked food. Cleanall worktops and utensils with care. Don’t make food for others if you’ve got diarrhoea.

Anyone can get travellers’ diarrhoea. High-risk parts of the world include Asia (particularly Southern Asia), the Middle East, Africa and Latin America. 20-60% of travellers visiting these areas get travellers’ diarrhoea.

Travellers’ diarrhoea is diagnosed based on your symptoms. If you have diarrhoea (3 or more loose stools in a day) while travelling or within 10 days of coming back from travelling, this can be classed as travellers’ diarrhoea. You may also have other symptoms - fever, sickness, vomiting, stomach cramps, or blood in your stools.

You should see a doctor if:

• your baby has six or more episodes of diarrhoea in 24 hours
• your child has six or more episodes of diarrhoea in 24 hours, has blood in their stools, has diarrhoea and vomiting at the same time, has very watery stools or has diarrhoea that lasts two weeks

As an adult, you should see a doctor if:

• you have diarrhoea with blood in it
• you have a high fever or severe abdominal pain
• you’re vomiting and unable to drink fluids to keep hydrated
• the diarrhoea is not getting better within 2 days
• you have other medical conditions - such as problems with your immune system, inflammatory bowel disease, kidney or heart problems
• you’re pregnant

About 10% of cases of travellers’ diarrhoea last over a week and about 2% for more than a month, according to a paper published by the British Medical Journal. If you have had continuous symptoms for longer than 10 days, see a doctor so that your stools can be checked for parasites, such as Giardia and Cryptosporidium. Between 5 and 10% of people who have had travellers’ diarrhoea later fulfil the criteria for irritable bowel syndrome. This is referred to as post-infection irritable bowel syndrome.

It can take up to 48 hours for loperamide to improve your symptoms. Keep taking the medication as directed and speak to a doctor if it does not help within two days. Like all antibiotics, you need to complete the course for azithromycin to work. Azithromycin will start working on the first day, but you may need to wait three days until you notice an improvement.

You can get loperamide and oral rehydration solution from the pharmacy. You need a prescription to get azithromycin.

Yes. Speak to your GP about getting azithromycin as a standby to take abroad with you.

Loperamide is a medicine that can help to stop diarrhoea. It makes the stools firmer, so you’ll need to pass them less often. It can take up to 48 hours for loperamide to improve your symptoms. Keep taking the medication as directed and speak to a doctor if it does not help within two days. You should not use loperamide if you have blood or mucus in your stool, or if you have a fever or severe stomach pains. Loperamide should not be used in children younger than 12 years.

Severe cases of diarrhoea may need to be treated with an antibiotic, such as azithromycin. If you are going abroad, you might like to ask your doctor for azithromycin, depending on where you are travelling to take with you just in case you fall ill and need it.

If you would like to take travellers’ diarrhoea treatment on your next trip, you can complete an online consultation for azithromycin through ZAVA. We offer free prescription and delivery once one of our doctors has checked that medication is suitable for you.

Loperamide is not suitable for everyone. Do not take loperamide if you're pregnant or breastfeeding. You should talk to your doctor before taking loperamide if you:

• are allergic to any of the ingredients
• have AIDS
• have dysentery
• have problems with your liver
• have conditions such as megacolon, colitis, ileus, slow gastrointestinal movements, constipation, abdominal distension
• if the medicine is for a child under 12 years old

If you bought loperamide without a prescription, you should also consult your doctor if you:

• are older than 40 and it is a while since you last had a bout of irritable bowel syndrome
• have recently passed blood in your stool
• have constipation, feel sick or are vomiting
• have lost your appetite
• have lost weight
• have recently been abroad
• have a fever
• have difficulty peeing (urinating), or if peeing hurts

The most common side effects of loperamide are: flatulence, headache, nausea and constipation.

Less common side effects are: dry mouth, dizziness, indigestion, a rash, sleepiness, stomach ache, vomiting. For rare side effects, please read the patient information leaflet.

Azithromycin is not suitable for everyone. You should consult your doctor before taking it if you:

• are allergic to macrolides, or any of the ingredients in the medicine
• have a slow heart rate
• have problems with your kidneys
• have liver disease
• have metabolic problems
• have neurological problems
• have or are at risk of a heart problem
• have psychiatric problems

Speak to your doctor about taking azithromycin if you're pregnant or breastfeeding.

The most common side effects of azithromycin are: diarrhoea, stomach cramps, feeling nauseous and vomiting.

Less commonly: change in sense of smell, allergic reactions, convulsions, dizziness, flatulence, headaches, itching, joint pain, decreased appetite, a rash, sleepiness, taste changes, problems with the vagina, watery stools.

For rare side effects, please read the patient information leaflet.