Travellers Diarrhoea

Travellers' diarrhoea is a collective term for diarrhoea and stomach upsets acquired during travel abroad, rather than at home. It is one of the most common travel-related illnesses, affecting up to 60% of travellers to high-risk destinations. Travellers' diarrhoea is most commonly caused by bacterial infections, particularly E. coli, Salmonella, Shigella and Campylobacter, contracted through contaminated food or water. Viral and parasitic infections can also be responsible, though less frequently. Symptoms of uncomplicated travellers' diarrhoea include three or more loose or watery stools per day, stomach cramps, nausea, vomiting, bloating and an urgent need to find a toilet. While these symptoms are not usually dangerous, they can be enough to disrupt your trip entirely. Most cases resolve within three to five days, but treatment can shorten the illness significantly and reduce the impact on your plans.

Antibiotics for the treatment of Travellers' Diarrhoea are appropriate for treating symptoms that we describe as moderate functional diarrhoea.

Moderate: distressing or interferes with planned activities.

Antibiotics are not usually indicated for:

Mild: tolerable, not distressing, does not interfere with planned activities.

Severe: incapacitating, or completely prevents planned activities, or dysentery (passing stools containing visible blood).

Persistent diarrhoea lasting 2 weeks.  

Severe and persistent diarrhoea will need medical attention.  Always see a doctor if your diarrhoea persists, or you have blood in your stools.
Most importantly, whether your symptoms are mild, moderate, severe or persistent, it is important to ensure you are properly hydrated.  Drink plenty of fluids and, where possible, try to replace the lost salts using rehydration solutions like Dioralyte.

Mild symptoms can be safely managed by taking rehydration salts like Dioralyte, or ORS and if needed, due to difficulty finding a toilet, Imodium.

Can't find ready-made rehydration salts? The World Health Organisation has a recipe for you to follow, and if all else fails, why not try flat (ie not fizzy) Coca-Cola with sugar?

The "Simple Solution" - Home-made Oral Rehydration Salts (ORS) Recipe

Six (6) level teaspoons of Sugar

Half (1/2) level teaspoon of Salt

One Litre of clean drinking or boiled water and then cooled

Adults and larger children should drink around 3 litres per day until they are well. 

Smaller children should receive between a quarter and a half of a cup (200ml), depending on their size at each feed.

Antibiotics are usually recommended for moderate to severe travellers' diarrhoea, particularly when symptoms are persistent, significantly disrupting your activities, or accompanied by fever. The most commonly prescribed antibiotics for travellers' diarrhoea include azithromycin and ciprofloxacin, with the choice depending on your destination, medical history and any drug allergies. An online consultation through TravelPharm or Peak Pharmacy allows a prescriber to assess your situation and determine whether antibiotics are appropriate, ensuring treatment is safe, targeted and used responsibly. Inappropriate or unnecessary use of antibiotics contributes to antimicrobial resistance, which is why they are reserved for cases where they will make a meaningful difference.

Travellers' diarrhoea is most commonly caused by bacteria found in contaminated food or water. The most frequent culprit is enterotoxigenic E. coli (ETEC), but Salmonella, Shigella and Campylobacter are also common depending on the region. Viral causes including norovirus and rotavirus account for a smaller proportion of cases, while parasitic infections such as Giardia and Cryptosporidium are less common but tend to cause longer-lasting symptoms. The risk is highest in regions with lower standards of food hygiene and water sanitation, including parts of South and Southeast Asia, Africa, Central and South America and the Middle East.

High-risk destinations include much of South and Southeast Asia (India, Nepal, Thailand, Vietnam, Cambodia), sub-Saharan Africa, North Africa and the Middle East, and Central and South America. The risk varies within countries, urban hotels with high hygiene standards carry less risk than rural areas or street food markets. Even in high-risk regions, careful food and water precautions can significantly reduce your chances of becoming ill. Moderate-risk destinations include Southern and Eastern Europe, China and parts of the Caribbean.

Prevention centres on careful food and water hygiene. Drink only bottled or boiled water and avoid ice in drinks unless you are confident it has been made from safe water. Eat food that has been freshly cooked and served hot — avoid buffets where food has been sitting at room temperature. Peel fruit yourself rather than eating pre-prepared fruit salads. Avoid raw salads, shellfish, unpasteurised dairy products and food from street vendors where hygiene is questionable. Wash your hands thoroughly with soap before eating or use an alcohol-based hand sanitiser. No prevention method is guaranteed, which is why carrying a standby treatment pack is sensible for trips to high-risk areas.

For trips to high-risk destinations, a sensible standby treatment kit should include oral rehydration sachets (such as Dioralyte), loperamide (Imodium) for symptomatic relief, and a standby course of antibiotics if prescribed following a consultation. Having these items ready in your luggage means you can begin treatment immediately if symptoms develop, rather than trying to find a pharmacy or doctor in an unfamiliar location. Through Peak Pharmacy's online service, you can arrange a consultation and obtain your standby travel medicines before you depart.

Most cases of travellers' diarrhoea resolve within three to five days without specific treatment, though symptoms can be unpleasant and disruptive during that time. With appropriate treatment, rehydration plus loperamide for mild cases, or antibiotics for moderate cases, the duration can be reduced to one to two days. If diarrhoea persists beyond 14 days, it is classified as persistent and requires medical investigation, as it may indicate a parasitic infection or other underlying cause that will not resolve with standard treatment.

Yes. Children are just as susceptible as adults and can become dehydrated more quickly due to their smaller body size. The same food and water precautions apply, and oral rehydration is particularly important for children. Loperamide (Imodium) is not suitable for children under 12. Antibiotics for children should only be prescribed following a medical consultation. If a child develops diarrhoea with a high fever, blood in stools, signs of dehydration (dry mouth, no tears, reduced urination, lethargy) or appears very unwell, seek medical attention promptly.

Travellers' diarrhoea itself is not directly contagious in the way a cold is passed between people. However, the bacteria and viruses that cause it can be spread through the faecal-oral route, meaning poor hand hygiene after using the toilet can transfer the infection to surfaces, food or other people. Thorough handwashing with soap and water (or using hand sanitiser) after using the toilet and before handling food is essential, both to protect yourself and to prevent spreading the infection to travel companions.

No. Prophylactic (preventative) antibiotics are not recommended for travellers' diarrhoea. Taking antibiotics before you are ill contributes to antimicrobial resistance, can cause unnecessary side effects, and disrupts your normal gut bacteria. The recommended approach is to carry a standby course of antibiotics prescribed by a clinician, to be used only if moderate to severe symptoms develop during your trip. This is known as "standby" or "self-treatment" prescribing and is the approach endorsed by UK travel health guidelines.

The terms are often used interchangeably, but there is a distinction. Food poisoning refers to illness caused by eating contaminated food, regardless of where you are. Travellers' diarrhoea specifically refers to diarrhoea acquired during travel abroad, typically to regions with different food hygiene standards and water quality. The causes overlap significantly, both are commonly caused by bacteria such as E. coli and Salmonella, but travellers' diarrhoea also encompasses infections from contaminated water, which is less common in the UK. The treatment approach is similar: rehydration, symptomatic relief, and antibiotics only when clinically appropriate.

You should see your GP if your diarrhoea persists for more than 14 days after returning to the UK, if you notice blood or mucus in your stools, if you have a persistent fever, if you are experiencing significant unexplained weight loss, or if you feel generally unwell after your return. Persistent symptoms may indicate a parasitic infection such as Giardia or amoebic dysentery, which requires specific testing and treatment that differs from standard bacterial travellers' diarrhoea. Always mention your travel history to your doctor, including the countries visited and the dates of travel.