Traveller's diarrhoea is a common problem among travellers, typically caused by the consumption of contaminated food or water. Predominantly caused by bacteria.
Prevention strategies include careful selection of food and beverages, though these are not fail-safe. Prophylactic antibiotics are not recommended for most travellers.
Management is self-diagnosis while still travelling, followed by hydration, medicine for symptom relief, and possibly, antibiotics. Antibiotic therapy is generally reserved for moderate to severe infections.
In healthy patients, resolution is typically within 3 to 5 days even without antibiotic treatment.
Traveller's diarrhoea (TD) is defined as ≥3 unformed stools in 24 hours accompanied by at least 1 of the following: fever, nausea, vomiting, cramps, tenesmus, or bloody stools (dysentery) during a trip abroad, typically to a low- or middle-income country. It is usually a benign self-limited illness lasting 3 to 5 days.
History and exam
Key diagnostic factors
- presence of risk factors
- diarrhoea (with or without tenesmus), cramping, nausea, and vomiting
- dysentery (blood and fever)
- persistent diarrhoea >14 days
Other diagnostic factors
- diarrhoea without illness
- travel to a high-risk destination
- age <30 years
- decreased stomach acidity
- prior TD susceptibility
- chronic disease, immunocompromise
- travellers with prior residence in developing country visiting friends and relatives
- travel during hot and wet seasons
1st investigations to order
- stool culture and sensitivity
- stool occult blood
- multi-pathogen molecular diagnostic (polymerase chain reaction)
- stool ova and parasite examination
Investigations to consider
- protozoal stool antigens
- Clostridium difficile stool toxin
- colonoscopy, endoscopy, and biopsy
- haematology, blood chemistries, serology
non-pregnant adults: mild diarrhoea
non-pregnant adults: moderate diarrhoea
non-pregnant adults: severe diarrhoea
Mark Riddle, MD, MPH&TM, DrPH, C Trop Med, Certificate in Travel Health
Professor and Chair
Department of Preventive Medicine & Biostatistics
Uniformed Services University of the Health Sciences
MR has given talks on the management of traveller's diarrhoea for the International Society of Travel Medicine (ISTM), CDC Foundation, American College of Gastroenterology (ACG), and American College of Preventive Medicine. MR has led the development of guidelines for traveller's diarrhoea for the ISTM, ACG, and the US Department of Defense. This work has been unpaid but support for travel has been accepted. MR is an author of several references cited in this topic.
Dr Mark Riddle would like to gratefully acknowledge Professor Gregory Juckett, the previous contributor to this topic.
GJ declares that he has no competing interests.
Andrea Summer, MD
Assistant Professor of Pediatrics
Medical University of South Carolina
AS declares that she has no competing interests.
Phil Fischer, MD
Professor of Pediatrics
Department of Pediatric and Adolescent Medicine
PF is an author of a reference cited in this topic.
- Irritable bowel syndrome
- Secondary disaccharidase (or other dietary) deficiency
- Malabsorptive conditions
- CDC Yellow Book: travelers' diarrhea
- 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea
Diarrhoea in adultsMore Patient leaflets
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