DEALING WITH DIARRHOEA

Diarrhoeal illness, though completely preventable, is very common in travellers and can spoil the holiday. Most travellers' diarrhoea results from swallowing contaminated food and drink, and is avoidable with precautions (see below).

Diarrhoeal illness will usually get better after one to three days with no treatment other than fluid replacement.

Hints on safe eating and drinking abroad
Food choice

• Choose food that must have been freshly cooked, e.g. omelettes.
• Freshly boiled food is always safe, e.g. rice.
• Peel all fruit and vegetables before eating (but water melons are suspect as they are sometimes injected with tap water).
• Eat food from sealed packs or cans.
• Don't eat: salads, shellfish and prawns, unpeeled fruit or vegetables, ice-cream and ices, or food from street stalls.
• Sauces and relishes left out on the table or food on which insects have settled will be infected.
• Remember contaminated plates and cutlery not washed with detergent or rinsed in clean water and protected from flies can cause infection.
• Hands and fingers should be washed at every opportunity. Only eat food that you have handled if your hands are scrupulously clean.

Drinking water

• Contaminated water is a very frequent source of diarrhoeal illness in travellers. Outside Western Europe, North America, Australia, New Zealand and Singapore, the water is nearly always suspect. Along the shores of the Mediterranean it may also be contaminated.
• When travelling it is best to assume that water supplies harbour disease. Hotel tap water should be sterilised (see below) and in the Tropics, Asia and Africa sterilised water should even be used for cleaning teeth.
• Water can be sterilised by adding purifying tablets (bought from any chemist) and will be fit for consumption within half an hour of treatment. The iodine taste can be disguised by the addition of orange. Water can also be sterilised by boiling. There are also numerous commercial filtration kits available.
• Ice for drinks is a frequent source of diarrhoeal infection and should be avoided.
• Ideally one should drink commercially bottled water with an intact seal (carbonated is best as it is less likely to have been topped up with tap water), but in some countries such as India and China even the commercial supplies may be contaminated.
• The necks of bottles and tops of tins of commercial drinks also carry disease and should be cleaned with wet medicated wipes before being used as drinking receptacles.
• Drinking straws should be avoided unless individually wrapped, as they may have been washed in contaminated water.

Treating diarrhoea

• Diarrhoea and vomiting developed when abroad requires treatment by fluid replacement, and this requires copious input of fluids in small amounts. This can best be achieved by using bottles of flat coke or carbonated drinks. A commercial rehydration preparation (e.g. Dioralyte or Rehidrat) may be carried. If you are not carrying one of these, mix 250 ml of fruit juice or water with a pinch of table salt and a teaspoon of sugar.
• Rapid rehydration is especially important in children, the elderly, and those with kidney problems.
• Commercial anti-diarrhoea preparations should not be used in children, and should only be used in adults if diarrhoea persists for over two days. If diarrhoea persists this long, medical help should be sought.

Note

Diarrhoea may interfere with the absorption of the contraceptive pill, and other alternative contraception may be advisable.

This paper first appeared in Travel Clinics - A primary care manual
It was sponsored by SmithKline Beecham Vaccines Group