Management

Aim of treatment is to:

• avoid dehydration
  • important in all form of diarrhoea and in most mild cases is the only treatment necessary
  • specific oral rehydration salts or potable fluids ad libitum can be used to maintain hydration
• reduce the severity and duration of symptoms
  • commonly used drugs include
    • bismuth subsalicylate
      • recommended for people with mild diarrhoea
      • decreases the number of loose stools by about 50%
      • should be avoided in patints with aspirin allergy and is not recommended for children aged <3 years
    • an antimotility agent
      • loperamide is the drug of choice – not indicated in young children, those with diarrhoea and fever (>38.5°C), or when there is gross blood in the stools
    • can be considered alone for mild to modertae diarrhoea
• prevent interruption to planned activities
  • empiric treatment with an antibiotic directed at enteric bacterial pathogens is the principal element in the treatment of traveller's diarrhoea
    • a 3-5 day course of antibiotics has been shown to reduce the average duration of illness from 4.5 to 1.5 days
    • refer prophylaxis and treatment for traveller’s diarrhoea link for antibiotic regimes
  • combination therapy
    • single dose or short course antibiotics plus loperamide has been shown to be effective than an antibiotic or loperamide alone
  • for protozoal infections, metronidazole, tinidazole, and nitazoxanide can be used

Travellers who self-medicate should be advised to seek medical help if they have severe abdominal pain or bloody diarrhoea. See other menu option.

Persistent diarrhoea following travel requires investigation if symptoms persist for more than 14 days e.g. stool culture and microscopy, proceeding to sigmoidoscopy and biopsy, etc.

Reference:

• (1) Hill DR, Ryan ET. Management of travellers' diarrhoea. BMJ. 2008;337:a1746.
• (2) Centers for Disease Control and Prevention (CDC) 2013. Yellow Book. Chapter 2 - For the Record: A History of the Definition & Management of Travelers’ Diarrhea