Pathogens which may be responsible for travellers diarrhoea are shown in the information box. Commonly. however, no organism is identified (around 60-70% of patients).
| SOME MICROBIAL CAUSES OF TRAVELLERS' DIARRHOEA |
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An attack of diarrhoea lasting 2-5 days commonly affects travellers particularly when visiting developing countries. The onset is usually abrupt and the stool is watery, Abdominal cramps, anorexia and vomiting are common and there may be fever. Examination of the abdomen usually shows no abnormality but there may be diffuse tenderness.
The disorder usually resolves spontaneously.
Antidiarrhoeal agents are best avoided, especially in children, as they may occasionally cause toxic dilatation of the bowel. Loperamide 4 mg will stop the diarrhoea if prolonged or very severe. Antibiotics are not necessary for mild attacks, especially as they may induce antibiotic resistance. Severe attacks can be aborted in most cases with two doses of 500 mg of ciprofloxacin 12 hours apart. Dehydration should be prevented by drinking of non-alcoholic fluids and the use of oral rehydration supplements in children, and in adults if the diarrhoea is severe.
The prevention of travellers' diarrhoea involves good hygienic practices, drinking clean water and avoiding uncooked vegetables. Doxycycline 100 mg or trimethoprim 80 mg daily will reduce the attack rate but these are best reserved for susceptible individuals. Boiling water is the safest decontamination method since cysts of Giardia and Cryptosporidium are highly chemically resistant.