Travelers diarrhoea - how to avoid it -

Travelers diarrhoea - how to avoid it -

Source: BMJ Clinical review

BMJ 2016;353:i1937 doi: 10.1136/bmj.i1937

1.  Boiling water, cooking food Thoroughly, and peeling fruit and vegetables.  
2.  Avoiding ice, shellfish, and condiments on restaurant tables.
3.  Using a straw to drink from bottles, and avoiding salads and buffets where food may have been unrefrigerated forsevera hours. 
4. Drink bottled water where available, including in alcoholic drinks, as alcohol does not sterilise non-bottled water. If bottled water is not available, water can be purified by boiling, filtering, or use of chlorine based tablets.
5.  Use alchohol hand gel may reduce diarrhoea rates in travellers.
6.  Hand washing with soap reduces the risk of diarrhoeal illness by 30-40%.

If you've got it anyway, use rehydration salts (or a mixture of six level teaspoons of sugar and half a teaspoon ofsalt in a litre of clean water if rehydration. 

salts are unavailable) (see http://rehydrate.org/rehydration/index.

html).

Loperamide (anti motility agent)  might be of help, but it should be  avoided in
the presence of severe abdominal pain or bloody diarrhoea which can signify invasive colitis.

Investigations (for diarrhoeal symptoms that persist beyond 14 days following
travel or sooner if there are other concerning features such as
fever or dysentery):

• full blood count,
•  liver and renal function,
•  inflammatory markers;
• stool samples for microscopy and culture; and examination for ova cysts, and parasites. 

The most common cause of long lasting diarrhoea after traveling is Giardia, easy treatable with 5 nitroimidazole, tinidazole 2 g once only or metronidazole 400 mg three times daily for five days.