Health Service Information On Reducing The Risks Of Traveller's Diarrhoea

Boil It - Cook It - Peel It - Or Forget It!

Where possible eat foods that have been freshly cooked and served hot. Avoid foods such as milk, ice cream, yoghurt, soft cheeses, cold meats, shellfish and other seafood, salads and soft skinned fruits. Foods that have been standing at room temperature for lengthy periods are unsafe. Busy restaurants with high food turnover are best. Shellfish concentrate Hepatitis A, Cholera and other diseases - don't eat them uncooked.

Avoid drinking or cleaning teeth in cold water unless it is known to be treated. The safest beverages are carbonated as the process kills most germs. Avoid using ice unless you know safe water was used to make it. The safety of water is increased by boiling for ten minutes at low altitudes, and longer at high altitudes. Allow one minute extra for every 300 metres.

Betadine antiseptic can be used to improve the quality of drinking water, but should only be used when boiling is difficult. 1ml is added to 1 litre of water and allowed to stand for 12 hours. Do not use iodine/Betadine if you have thyroid disease, are allergic to iodine, or are pregnant. Filters are not effective in removing all harmful viruses.

Scrupulous handwashing with soap before meals and after using the toilet is essential.

Travel vaccinations provide no protection against traveller's diarrhoea or intestinal parasites.

Treatment

Despite taking precautions, if you do get diarrhoea, there are some things you can do.

General

The most important thing is to replace lost fluids, preferably with an Oral Rehydration Solution such as "Gastrolyte" dissolved in boiled water. It is possible to for you to make an ORS. Using a 5 ml teaspoon add eight level spoons of sugar and half a level teaspoon of salt to one litre of boiled water. Avoid milk or alcohol as they may worsen symptoms. If diarrhoea is associated with frequent vomiting, a doctor should be seen.

Non Specific

Loose bowel actions occurring more frequently than three to four hours are inconvenient and justify treatment with anti-diarrhoeal agents. Do not use these medications when there is fever (38° or higher) or blood in the stool as this can indicate more sinister infection.

Watery bowel actions, without pain use Imodium capsules or Lomotil tablets. They should not be used for more than 48 hours.

Watery bowel actions with associated cramping pains can be relieved with Paracetamol and Codeine (Panadeine). This may be beneficial for the pain as well as the diarrhoea, and two may be taken every four to six hours.

Beware of dehydration, which is the major danger associated with any episode of diarrhoea and can be especially rapid in hot and humid climates.

Specific Treatment Regimes

There are times when a specific antibiotic may be of assistance in cleating the bowel infection. Speak to the doctor about the prescription of these medicines.

Blood Stained Stools

Norfloxacin - This antibiotic is for complicated diarrhoea with associated fever (>38°) or blood stained stool.

Persistent/Bulky (Not Watery) Loose Stools

Metronidizole - This agent is a treatment for Giardia Lamblia a more persistent bowel infection that can lead to ongoing nausea, loss of appetite and general weakness

Medications

Medication	Remedy	Dose	Side Effects
Paracetamol/Codeine	Relieves cramping pains. Codeine is useful for slowing bowel movement.	Two tablets every four to six hours but not for more than 48 hours.	Codeine is sedating.
Imodium	Decreases the frequency of loose bowel actions. It is not to be used as a "stopper".	Two capsules after each loose bowel action to regulate bowel actions to approximately four hourly. No more than eight capsules in a twelve hour period.	Trying to stop diarrhoea makes the illness last longer.
Metronidazole	An agent that treats Giardiasis, a bowel parasite that produces bulky, foul smelling, loose bowel actions.	Five tablets per day evenly spaced.	A potentially toxic interaction occurs with alcohol.
Norfloxacin	Antibiotic for complicated bacterial diarrhoea with fever or the passing of mucous or blood. It should not be used for simple diarrhoea, where germ transit is encouraged. If bowel actions have persisted for more than 48 hours, then it is appropriate to take a course of Norfloxacin.	One tablet twice a day for three days.	This antibiotic may be less effective if taken with vitamin preparations.