travellers diarrhoea with blood

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Traveler's diarrhea

Gastrointestinal tract

Your digestive tract stretches from your mouth to your anus. It includes the organs necessary to digest food, absorb nutrients and process waste.

Traveler's diarrhea is a digestive tract disorder that commonly causes loose stools and stomach cramps. It's caused by eating contaminated food or drinking contaminated water. Fortunately, traveler's diarrhea usually isn't serious in most people — it's just unpleasant.

When you visit a place where the climate or sanitary practices are different from yours at home, you have an increased risk of developing traveler's diarrhea.

To reduce your risk of traveler's diarrhea, be careful about what you eat and drink while traveling. If you do develop traveler's diarrhea, chances are it will go away without treatment. However, it's a good idea to have doctor-approved medicines with you when you travel to high-risk areas. This way, you'll be prepared in case diarrhea gets severe or won't go away.

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Traveler's diarrhea may begin suddenly during your trip or shortly after you return home. Most people improve within 1 to 2 days without treatment and recover completely within a week. However, you can have multiple episodes of traveler's diarrhea during one trip.

The most common symptoms of traveler's diarrhea are:

Suddenly passing three or more looser watery stools a day.
An urgent need to pass stool.
Stomach cramps.

Sometimes, people experience moderate to severe dehydration, ongoing vomiting, a high fever, bloody stools, or severe pain in the belly or rectum. If you or your child experiences any of these symptoms or if the diarrhea lasts longer than a few days, it's time to see a health care professional.

When to see a doctor

Traveler's diarrhea usually goes away on its own within several days. Symptoms may last longer and be more severe if it's caused by certain bacteria or parasites. In such cases, you may need prescription medicines to help you get better.

If you're an adult, see your doctor if:

Your diarrhea lasts beyond two days.
You become dehydrated.
You have severe stomach or rectal pain.
You have bloody or black stools.
You have a fever above 102 F (39 C).

While traveling internationally, a local embassy or consulate may be able to help you find a well-regarded medical professional who speaks your language.

Be especially cautious with children because traveler's diarrhea can cause severe dehydration in a short time. Call a doctor if your child is sick and has any of the following symptoms:

Ongoing vomiting.
A fever of 102 F (39 C) or more.
Bloody stools or severe diarrhea.
Dry mouth or crying without tears.
Signs of being unusually sleepy, drowsy or unresponsive.
Decreased volume of urine, including fewer wet diapers in infants.

It's possible that traveler's diarrhea may stem from the stress of traveling or a change in diet. But usually infectious agents — such as bacteria, viruses or parasites — are to blame. You typically develop traveler's diarrhea after ingesting food or water contaminated with organisms from feces.

So why aren't natives of high-risk countries affected in the same way? Often their bodies have become used to the bacteria and have developed immunity to them.

Risk factors

Each year millions of international travelers experience traveler's diarrhea. High-risk destinations for traveler's diarrhea include areas of:

Central America.
South America.
South Asia and Southeast Asia.

Traveling to Eastern Europe, South Africa, Central and East Asia, the Middle East, and a few Caribbean islands also poses some risk. However, your risk of traveler's diarrhea is generally low in Northern and Western Europe, Japan, Canada, Singapore, Australia, New Zealand, and the United States.

Your chances of getting traveler's diarrhea are mostly determined by your destination. But certain groups of people have a greater risk of developing the condition. These include:

Young adults. The condition is slightly more common in young adult tourists. Though the reasons why aren't clear, it's possible that young adults lack acquired immunity. They may also be more adventurous than older people in their travels and dietary choices, or they may be less careful about avoiding contaminated foods.
People with weakened immune systems. A weakened immune system due to an underlying illness or immune-suppressing medicines such as corticosteroids increases risk of infections.
People with diabetes, inflammatory bowel disease, or severe kidney, liver or heart disease. These conditions can leave you more prone to infection or increase your risk of a more-severe infection.
People who take acid blockers or antacids. Acid in the stomach tends to destroy organisms, so a reduction in stomach acid may leave more opportunity for bacterial survival.
People who travel during certain seasons. The risk of traveler's diarrhea varies by season in certain parts of the world. For example, risk is highest in South Asia during the hot months just before the monsoons.

Complications

Because you lose vital fluids, salts and minerals during a bout with traveler's diarrhea, you may become dehydrated, especially during the summer months. Dehydration is especially dangerous for children, older adults and people with weakened immune systems.

Dehydration caused by diarrhea can cause serious complications, including organ damage, shock or coma. Symptoms of dehydration include a very dry mouth, intense thirst, little or no urination, dizziness, or extreme weakness.

Watch what you eat

The general rule of thumb when traveling to another country is this: Boil it, cook it, peel it or forget it. But it's still possible to get sick even if you follow these rules.

Other tips that may help decrease your risk of getting sick include:

Don't consume food from street vendors.
Don't consume unpasteurized milk and dairy products, including ice cream.
Don't eat raw or undercooked meat, fish and shellfish.
Don't eat moist food at room temperature, such as sauces and buffet offerings.
Eat foods that are well cooked and served hot.
Stick to fruits and vegetables that you can peel yourself, such as bananas, oranges and avocados. Stay away from salads and from fruits you can't peel, such as grapes and berries.
Be aware that alcohol in a drink won't keep you safe from contaminated water or ice.

Don't drink the water

When visiting high-risk areas, keep the following tips in mind:

Don't drink unsterilized water — from tap, well or stream. If you need to consume local water, boil it for three minutes. Let the water cool naturally and store it in a clean covered container.
Don't use locally made ice cubes or drink mixed fruit juices made with tap water.
Beware of sliced fruit that may have been washed in contaminated water.
Use bottled or boiled water to mix baby formula.
Order hot beverages, such as coffee or tea, and make sure they're steaming hot.
Feel free to drink canned or bottled drinks in their original containers — including water, carbonated beverages, beer or wine — as long as you break the seals on the containers yourself. Wipe off any can or bottle before drinking or pouring.
Use bottled water to brush your teeth.
Don't swim in water that may be contaminated.
Keep your mouth closed while showering.

If it's not possible to buy bottled water or boil your water, bring some means to purify water. Consider a water-filter pump with a microstrainer filter that can filter out small microorganisms.

You also can chemically disinfect water with iodine or chlorine. Iodine tends to be more effective, but is best reserved for short trips, as too much iodine can be harmful to your system. You can purchase water-disinfecting tablets containing chlorine, iodine tablets or crystals, or other disinfecting agents at camping stores and pharmacies. Be sure to follow the directions on the package.

Follow additional tips

Here are other ways to reduce your risk of traveler's diarrhea:

Make sure dishes and utensils are clean and dry before using them.
Wash your hands often and always before eating. If washing isn't possible, use an alcohol-based hand sanitizer with at least 60% alcohol to clean your hands before eating.
Seek out food items that require little handling in preparation.
Keep children from putting things — including their dirty hands — in their mouths. If possible, keep infants from crawling on dirty floors.
Tie a colored ribbon around the bathroom faucet to remind you not to drink — or brush your teeth with — tap water.

Other preventive measures

Public health experts generally don't recommend taking antibiotics to prevent traveler's diarrhea, because doing so can contribute to the development of antibiotic-resistant bacteria.

Antibiotics provide no protection against viruses and parasites, but they can give travelers a false sense of security about the risks of consuming local foods and beverages. They also can cause unpleasant side effects, such as skin rashes, skin reactions to the sun and vaginal yeast infections.

As a preventive measure, some doctors suggest taking bismuth subsalicylate, which has been shown to decrease the likelihood of diarrhea. However, don't take this medicine for longer than three weeks, and don't take it at all if you're pregnant or allergic to aspirin. Talk to your doctor before taking bismuth subsalicylate if you're taking certain medicines, such as anticoagulants.

Common harmless side effects of bismuth subsalicylate include a black-colored tongue and dark stools. In some cases, it can cause constipation, nausea and, rarely, ringing in your ears, called tinnitus.

Feldman M, et al., eds. Infectious enteritis and proctocolitis. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 11th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed May 25, 2021.
LaRocque R, et al. Travelers' diarrhea: Microbiology, epidemiology, and prevention. https://www.uptodate.com/contents/search. Accessed May 26, 2021.
Ferri FF. Traveler diarrhea. In: Ferri's Clinical Advisor 2023. Elsevier; 2023. https://www.clinicalkey.com. Accessed April 28, 2023.
Diarrhea. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/diarrhea. Accessed April 27, 2023.
Travelers' diarrhea. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/yellowbook/2020/preparing-international-travelers/travelers-diarrhea. Accessed April 28, 2023.
LaRocque R, et al. Travelers' diarrhea: Clinical manifestations, diagnosis, and treatment. https://www.uptodate.com/contents/search. Accessed May 26, 2021.
Khanna S (expert opinion). Mayo Clinic. May 29, 2021.
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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Travelers diarrhea.

Noel Dunn ; Chika N. Okafor .

Affiliations

Last Update: July 4, 2023 .

Continuing Education Activity

Traveler's diarrhea is a common ailment in individuals traveling to resource-limited destinations overseas. It is estimated to affect nearly 40 to 60 percent of travelers and is the most common travel-associated condition. Bacterial, viral, and parasitic infections can cause symptoms, though bacterial sources represent the most frequent etiology. Although traveler's diarrhea is typically a benign, self-resolving condition, it can lead to dehydration and, in severe cases, significant complications. This activity reviews the evaluation and management of traveler's diarrhea and highlights the role of interprofessional team members in collaborating to provide well-coordinated care and enhance outcomes for affected patients.

Identify the causes of traveler's diarrhea.
Identify strategies to prevent traveler's diarrhea.
Explain the management of traveler's diarrhea.
Explain the importance of improving coordination amongst the interprofessional team to enhance care for patients affected by traveler's diarrhea.
Introduction

Travelers’ diarrhea is a common ailment in persons traveling to resource-limited destinations overseas. Estimates indicate that it affects nearly 40% to 60% of travelers depending on the place they travel, and it is the most common travel-associated condition. Bacterial, viral, and parasitic infections can cause symptoms, though bacterial sources represent the most frequent etiology. While travelers’ diarrhea is typically a benign self-resolving condition, it can lead to dehydration and, in severe cases, significant complications. [1] [2] [3]

The most common bacterial cause is enterotoxigenic Escherichia coli (ETEC), with estimates that the bacteria is responsible for nearly 30% of cases. Other common bacterial causes of travelers’ diarrhea include Campylobacter jejuni , Shigella , and Salmonella species. Norovirus is the most common viral cause while rotavirus is another source of infection. Giardia intestinalis is the most common parasitic source while Cryptosporidium and Entamoeba histolytica can also cause travelers’ diarrhea. The most common cause of travelers’ diarrhea varies by region, though the source is rarely identified in less severe cases. [4] [5] [6]

Traveler's diarrhea can occur in both short and long term travelers; in general, there is no immunity against future attacks. Traveler's diarrhea appears to be most common in warmer climates, in areas of poor sanitation and lack of refrigeration. In addition, the lack of safe water and taking short cuts to preparing foods are also major risk factors. In areas where food handling education is provided, rates of traveler's diarrhea are low.

Epidemiology

Estimates place the incidence of travelers’ diarrhea at 30% to 60% of travelers to resource-limited destinations. Incidence and causal agent vary by destination, with the highest incidence reported in sub-Saharan Africa. Other locations with high incidence include Latin America, the Middle East, and South Asia. Risk factors are typically related to poor hygiene in resource-limited areas. These include poor hygienic practices in food handling and preparation; lack of refrigeration due to inadequate electrical supply; and poor food storage practices. Additional modifiable risk factors include proton pump inhibitor (PPI) use, recent antibiotic use, and unsafe sexual practices. Risk factors for severe complications are pregnancy, young or old age, travelers with underlying chronic gastrointestinal diseases, or people who are immunocompromised. [7] [8]

Pathophysiology

Travelers’ diarrhea is most commonly spread by fecal-oral transmission of the causative organism, typically through consumption of contaminated food or water. The incubation period varies by causal agent, with viruses and bacteria ranging from 6 to 24 hours and intestinal parasites requiring 1 to 3 weeks before the onset of symptoms. The pathophysiology for travelers’ diarrhea differs by a causative agent but can be split into non-inflammatory or inflammatory pathways. Non-inflammatory agents cause a decrease in the absorptive abilities of the intestinal mucosa, thereby increasing the output of the gastrointestinal (GI) tract. Inflammatory agents on the other hand cause destruction of the intestinal mucosa either through cytotoxin release or direct invasion of the mucosa. The loss of mucosa surface again results in a decrease of absorption with a resultant increase in bowel movements. [9]

History and Physical

The onset of symptoms will typically occur 1 to 2 weeks after arrival in a resource-limited destination, though travelers can develop symptoms throughout their stay or shortly after arrival. Travelers’ diarrhea is considered as three or more loose stools in 24 hours or a two-fold increase from baseline bowel habits. Diarrhea often occurs precipitously and is accompanied by abdominal cramping, fever, nausea, or vomiting. Patients should be asked about any blood in their stool, fevers, or any associated symptoms. A thorough travel history should be obtained including timeline and itinerary, diet and water consumption at their destination, illnesses in other travelers, and possible sexual exposures.

In most self-limited cases physical examination will show mild diffuse abdominal tender to palpation. Providers should assess for dehydration through skin turgor and capillary refill. In more severe cases patients may have severe abdominal pain, high fever, and evidence of hypovolemia (tachycardia, hypotension).

Laboratory investigation is typically not required in most cases. In patients with concerning features, such as with high fever, hematochezia, or tenesmus, stool studies can be obtained. Typical stool studies include stool culture, fecal leukocytes, and lactoferrin. The stool should be assessed for ova and parasites in patients with longer duration of symptoms. New multiplex polymerase chain reaction (PCR) screens are becoming available and provide quick analysis of multiple stool pathogens. These screens, however, are expensive, are not widely available, and may not change the clinical management of patients. [4]

Radiological studies are not required in most cases. Kidneys, ureters, and bladder x-ray can be obtained to assess for acute intra-abdominal pathology or look for evidence of perforation in severe cases. An abdominal CT can also be used to assess for intraabdominal pathology in severe cases.

Treatment / Management

Travelers should be counseled on risk reduction before travel, including avoiding tap water & ice, frequent hand washing, avoiding leafy vegetables or fruit that isn’t peeled, and avoiding street food. Bismuth subsalicylate (two tabs 4 times a day) can be used for prophylaxis and can reduce the incidence of travelers’ diarrhea by almost half, though it should be avoided in children and pregnant women due salicylate side effects. In short high-stakes travel, it may be reasonable to start antibiotics as prophylaxis but is generally avoided in longer-term travel. Rifaximin is a commonly used chemoprophylaxis due to its minimal absorption and minimal side effects. [10] [11] [12]

The foundation of diarrhea management is fluid repletion. In mild cases, travelers should focus on increasing water intake. Water is usually sufficient though sports drinks and other electrolyte fluids can be used. Pedialyte can be used for pediatric patients. Milk and juices should be avoided as this can worsen diarrhea. In more severe cases, oral rehydration salt can be used to ensure rehydration with adequate electrolyte repletion. In cases of severe dehydration, IV fluids may ultimately be required.

Treatment is supportive in mild-moderate cases. In patients without signs of inflammatory diarrhea, loperamide can be used for symptomatic relief. The typical dose for adults is 4 mg initially with 2 mg after each subsequent loose stool, not to exceed 16 mg total in a day.

Also, travelers can be given antibiotics to take as needed at the onset of symptoms. Ciprofloxacin is commonly used for treatment, though there are concerns with resistance with Campylobacter species. For this reason, fluoroquinolones are not often prescribed for travelers to Asia and azithromycin preferable. Also, azithromycin is often prescribed for pregnant travelers and children. A common regimen is 500 mg daily for three days, though evidence suggests that a single dose of 1000 mg may be slightly more effective. Parents can be given azithromycin powder with instructions to mix with water when needed. Rifaximin is a minimally absorbed antibiotic that is also available and is safe for older children and pregnant travelers.

Differential Diagnosis
Pseudomembranous colitis
Ischemic colitis
Radiation-induced colitis
Food poisoning

New Guidelines for Traveler's Diarrhea

Travelers should be advised against the use of prophylactic antibiotics
In high-risk groups, one may consider antibiotic prophylaxis
Bismuth subsalicylate can be considered in any traveler.
The antibiotic of choice is rifaximin
Fluoroquinolones should not be used as prophylaxis

The outcomes in most patients with traveler's diarrhea are good. However, in severe cases, dehydration can occur requiring admission.

Complications
Dehydration
Malabsorption
Hemolytic uremic syndrome
Reactive arthritides
Postoperative and Rehabilitation Care

The majority of patients are managed as outpatients and need to do the following:

Maintain hydration
Hand washing
Only take antimotility agents if prescribed by the healthcare provider
Maintain good personal hygiene
If diarrhea persists for more than 10 days, should follow up with the primary provider
Deterrence and Patient Education
Wash hands regularly
Avoid shellfish from waters that are contaminated
Wash all foods before consumption
Drink bottled water when traveling
Avoid consumption of raw poultry or eggs
When traveling, consume dry foods and carbonated beverages
Avoid water and ice from the street
Avoid drinking water from lakes and rivers
Pearls and Other Issues

There is a strong correlation with travelers’ diarrhea and the subsequent development of irritable bowel syndrome (IBS), with some studies suggesting up to 50% incidence.

Enhancing Healthcare Team Outcomes

The key to traveler's diarrhea is preventing it. Today, nurses, the primary care provider and the pharmacists are in the prime position to educate the patient on the importance of hydration and good hygiene. The traveler should be educated on drinking bottled water and washing all fresh fruit and vegetables prior to consumption. Plus, travelers should be warned not to drink from lakes and streams. Carrying small packets of alcohol desansitizer to wash hands can be very helpful when hand washing is not possible.

The pharmacist should educate the traveler on managing the symptoms of diarrhea with over-the-counter medications or loperamide. Travelers should be discouraged from taking prophylactic antibiotics when traveling, as this leads to more harm than good. Finally, the traveler should be educated on the symptoms of dehydration and when to seek medical care. The primary care clinicians should monitor patients until there is a complete resolution of symptoms. Any patient that fails to improve within a few days should be referred to a specialist for further workup. With open communication between the team members, the morbidity of traveler's diarrhea can be reduced. [1] [8] (level V)

The prognosis for most patients with traveler's diarrhea is excellent. However, thousands of patients go to the emergency departments each year looking for a magical cure. Hydration is the key and admission is only required for severe dehydration and orthostatic hypotension. The elderly and children under the age of 4 are at the highest risk for developing complications, which often occur because of self-prescribing of over-the-counter medications. [13] [14] (Level V)

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Disclosure: Noel Dunn declares no relevant financial relationships with ineligible companies.

Disclosure: Chika Okafor declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

Cite this Page Dunn N, Okafor CN. Travelers Diarrhea. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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Travelers' Diarrhea

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Travelers' diarrhea is the most common travel-related illness. It can occur anywhere, but the highest-risk destinations are in Asia (except for Japan and South Korea) as well as the Middle East, Africa, Mexico, and Central and South America.

In otherwise healthy adults, diarrhea is rarely serious or life-threatening, but it can make a trip very unpleasant.

You can take steps to avoid travelers’ diarrhea

Choose food and drinks carefully Eat only foods that are cooked and served hot. Avoid food that has been sitting on a buffet. Eat raw fruits and vegetables only if you have washed them in clean water or peeled them. Only drink beverages from factory-sealed containers, and avoid ice because it may have been made from unclean water.
Wash your hands Wash your hands often with soap and water, especially after using the bathroom and before eating. If soap and water aren’t available, use an alcohol-based hand sanitizer. In general, it’s a good idea to keep your hands away from your mouth.

Learn some ways to treat travelers’ diarrhea

Drink lots of fluids If you get diarrhea, drink lots of fluids to stay hydrated. In serious cases of travelers’ diarrhea, oral rehydration solution—available online or in pharmacies in developing countries—can be used for fluid replacements.
Take over-the-counter drugs Several drugs, such as loperamide, can be bought over-the-counter to treat the symptoms of diarrhea. These drugs decrease the frequency and urgency of needing to use the bathroom, and may make it easier for you to ride on a bus or airplane while waiting for an antibiotic to take effect.
Only take antibiotics if needed Your doctor may give you antibiotics to treat travelers’ diarrhea, but consider using them only for severe cases. If you take antibiotics, take them exactly as your doctor instructs. If severe diarrhea develops soon after you return from your trip, see a doctor and ask for stool tests so you can find out which antibiotic will work for you.

More Information

Travelers’ Diarrhea- CDC Yellow Book

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Traveler's Diarrhea

What is traveler's diarrhea, what causes traveler's diarrhea.

It’s caused by drinking water or eating food that has bacteria, viruses, or parasites. Most traveler's diarrhea is from bacteria. Diarrhea from viruses and parasites is less common. Food and water can be infected by people:

Not washing hands after using the bathroom
Storing food unsafely
Handling and preparing food unsafely
Not cleaning surfaces and utensils safely

Who is at risk for traveler's diarrhea?

You are at risk for this condition if you travel to a country that has poor public sanitation and hygiene. Poor hygiene in local restaurants is also a risk factor. Places that have the highest risk are often in developing countries in:

Central and South America
The Middle East

If you travel to a developing country, you are more likely to get this illness if you eat food or have drinks:

Bought on the street, such as from a food cart
In someone’s home
At lodging that provides all meals (all-inclusive)

You’re also at increased risk if you:

Take some kinds of ulcer medicine
Have had some kinds of gastrointestinal surgery

What are the symptoms of traveler's diarrhea?

The main symptom is loose stool that occurs suddenly. The stool may be watery. Other symptoms may include:

Belly (abdominal) pain or cramps
Blood in the stool
Trouble waiting to have a bowel movement (urgency)
Feeling tired

In most cases, symptoms last less than a week.

How is traveler's diarrhea diagnosed?

How is traveler's diarrhea treated, what are possible complications of traveler's diarrhea.

The loss of body fluid from diarrhea and vomiting can lead to dehydration. This can be serious. Contact your healthcare provider if you are not urinating as much as usual.

A small number of people can develop post-infectious irritable bowel syndrome. This can cause symptoms such as:

Long-term diarrhea
Belly pain and cramping

What can I do to prevent traveler's diarrhea?

You can take steps to prevent traveler's diarrhea.

Only use water that has been boiled or chemically disinfected for:

Making tea or coffee
Brushing your teeth
Washing your face
Washing your hands (or use alcohol-based gel)
Washing fruits and vegetables
Washing food utensils, equipment, or surfaces
Washing the surfaces of food or drink tins, cans, and bottles

Don't eat foods such as:

Raw fruits, vegetables, or salad greens
Unpasteurized milk, cheese, ice cream, or yogurt
Any fish caught in tropical reefs rather than the open ocean
Condiments that are left on the table, such as ketchup, mustard, sauces, or dips

Also make sure to:

Not eat food from unknown sources
Not put ice in drinks
Only have drinks that are bottled and sealed
Use drinking straws instead of drinking directly from glasses or cups
Only take antibiotic or antidiarrheal medicine if advised by your health care provider (these can make symptoms worse, which can be dangerous)

When should I call my healthcare provider?

Call a healthcare provider if you:

Have diarrhea that is severe or bloody
Have belly pain that is getting worse or not going away
Have a high fever
Are not getting better within a few days
Have signs of dehydration, such as urinating less
Traveler's diarrhea occurs within 10 days of travel to an area with poor public hygiene. It’s the most common illness in travelers.
It’s caused by drinking water or eating foods that have bacteria, viruses, or parasites.
It usually goes away without treatment in a few days.
Dehydration from diarrhea can be serious. You need to replace body fluid that has been lost.
See a healthcare provider if your symptoms are severe or last for more than a few days.
You can prevent it by avoiding unsafe water and not eating unsafe foods.

Tips to help you get the most from a visit to your healthcare provider:

Know the reason for your visit and what you want to happen.
Before your visit, write down questions you want answered.
Bring someone with you to help you ask questions and remember what your provider tells you.
At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
Ask if your condition can be treated in other ways.
Know why a test or procedure is recommended and what the results could mean.
Know what to expect if you do not take the medicine or have the test or procedure.
If you have a follow-up appointment, write down the date, time, and purpose for that visit.
Know how you can contact your provider if you have questions.

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Traveler’s Diarrhea

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More Information |

Traveler’s diarrhea is an infection characterized by diarrhea, nausea, and vomiting that commonly occur in travelers to areas of the world with poor water purification.

Traveler's diarrhea can be caused by bacteria, parasites, or viruses.

Organisms that cause the disorder are usually acquired from food or water, especially in countries where the water supply may be inadequately treated.

Nausea, vomiting, abdominal cramping, and diarrhea can occur with any degree of severity.

The diagnosis is usually based on the doctor's evaluation, but sometimes stool is tested for organisms.

Treatment involves drinking plenty of safe fluids and sometimes taking antidiarrheal medications or antibiotics.

Preventive measures include drinking only bottled carbonated beverages, avoiding uncooked vegetables or fruits, not using ice cubes, and using bottled water to brush teeth.

(See also Overview of Gastroenteritis .)

Traveler’s diarrhea occurs when people are exposed to bacteria, viruses, or, less commonly, parasites to which they have had little exposure and thus no immunity. The organisms are usually acquired from food or water (including water used to wash foods).

Traveler’s diarrhea occurs mostly in countries where the water supply is inadequately treated.

The bacteria Escherichia coli ( E. coli ) is the organism most likely to cause traveler’s diarrhea, particularly the types of E. coli that produce certain toxins , and viruses such as norovirus , which has been a particular problem on some cruise ships.

Travelers who avoid drinking local water may still become infected by brushing their teeth with an improperly rinsed toothbrush, drinking bottled drinks with ice made from local water, or eating food that is improperly handled or washed with local water. People who take medications that decrease stomach acid (such as antacids, H2 blockers, and proton pump inhibitors) are at risk of developing a more severe illness.

Symptoms of Traveler’s Diarrhea

The following symptoms of traveler's diarrhea can occur in any combination and with any degree of severity:

Intestinal rumbling

Abdominal cramping

These symptoms begin 12 to 72 hours after ingesting contaminated food or water. Vomiting, headache, and muscle pain are particularly common in infections caused by norovirus. Rarely, diarrhea is bloody.

Most cases are mild and disappear without treatment within 3 to 5 days.

Diagnosis of Traveler’s Diarrhea

A doctor's evaluation

Rarely stool tests

Diagnostic tests are rarely needed, but sometimes stool samples are tested for bacteria, viruses, or parasites, typically in people who have fever, severe abdominal pain, and bloody diarrhea.

Treatment of Traveler’s Diarrhea

Medications that stop diarrhea (antidiarrheal medications)

Sometimes antibiotics or antiparasitic medications

These medications are not given to children under 18 years of age with acute diarrhea. Antidiarrheal medications are also not given to people who have recently used antibiotics, who have bloody diarrhea, who have small amounts of blood in the stool that are too small to be seen, or who have diarrhea and fever.

Antibiotics are not necessary for mild traveler's diarrhea.

Antiparasitic medications are given if a parasite is identified in the stool.

Travelers are encouraged to seek medical care if they develop fever or blood in the stool.

Prevention of Traveler’s Diarrhea

Safe consumption of food and water

Travelers should eat only in restaurants with a reputation for safety and should not consume any food or beverages from street vendors. Cooked foods that are still hot when served are generally safe. Salads containing uncooked vegetables or fruit and salsa left on the table in open containers should be avoided. Any fruit should be peeled by the traveler.

Travelers should drink only bottled carbonated beverages or beverages made with water that has been boiled. Even ice cubes should be made with water that has been boiled.

Buffets and fast food restaurants pose an increased risk of infection.

More Information

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

Centers for Disease Control and Prevention (CDC): Choose Safe Food and Drinks When Traveling

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Best Traveler's Diarrhea Treatments for Symptom Relief

Sources of Bacteria, Prevention, and Medication Types

Complications

Frequently asked questions.

Traveler's diarrhea can turn a trip into a nightmare. Food and water contaminated by germs, also known as pathogens , is not uncommon in certain areas of the world that are popular travel destinations. Consuming even small amounts of these germs can cause loose, watery stool, the main sign of diarrhea , Luckily, treatment options are available.

This article explains the symptoms of traveler's diarrhea, how to treat it, and the best ways to prevent getting infected in the first place.

Luis Alvarez / Getty Images

Symptoms of traveler's diarrhea caused by bacteria or a virus usually appear six to 72 hours after eating or drinking something contaminated. With some types of pathogens, it may take a week or longer for stool to be affected.

Changes in your bowel habits it the main symptoms of diarrhea. At its mildest, diarrhea involves passing loose, watery stool three times a day. You may pass unformed stool 10 or more times a day in severe cases.

Other symptoms vary depending on the type of bacterial or virus you've been exposed to but may include:

Stomach cramps
Tenesmus , feeling you need to have a bowel movement even when your bowels are empty
Mucous in stool

More severe cases of traveler's diarrhea may cause bloody stools .

Should You Go to a Doctor for Traveler's Diarrhea?

See a healthcare provider if your symptoms are accompanied by fever or bloody stools, or they last longer than 48 hours.

Traveler's Diarrhea Causes

The most common cause of traveler's diarrhea is probably poor hygiene (lack of cleanliness) in restaurants. You're most at risk when dining out in areas of Asia, the Middle East, Mexico, Africa, and South and Central America.

Pathogens are usually spread via the fecal-oral route . This means someone with the bacteria or virus excretes the germs in their feces. The feces may not be safely disposed of in a sanitary setting, or the infected person may not properly wash their hands before handling food and beverages. This allows germs to be transmitted to something you put into your mouth.

This cycle of contamination is most common in areas of the world that have specific conditions:

Warmer climates that promote germ growth
Poor sanitation (such as open sewage areas)
Unreliable refrigeration
Little education on safe food handling.

Common Bacterial Pathogens

The most common cause of traveler's diarrhea is bacteria, which are thought to lead to 80% to 90% of cases. These include:

Escherichia coli or E-coli
Campylobacter jejuni

Ingesting these bacterium causes gastroenteritis , which means the stomach and small intestines become inflamed. This leads to diarrhea.

Common Viral Pathogens

Viruses can also be transported via the fecal-oral route. The most common types of viruses that cause diarrhea include:

Viral infections of the digestive system are often referred to as stomach flu . The illness has no connection to respiratory influenza, but like the "flu," it usually lasts a short period.

Other Causes of Diarrhea

In addition to germs in your food and water, you could develop diarrhea from toxins, which cause the common symptoms of food poisoning .

Parasites , or protozoal pathogens, can also cause diarrhea. In these instances, you're more likely to develop symptoms one to two weeks after exposure to the pathogen.

Dehydration is one of the most common complications related to any form of diarrhea. Multiple bowel movements that release a lot of fluid can cause you to have too little water in your body.

Severe dehydration can lead to problems such as:

Fatigue and muscle weakness or pain
Dizziness or lightheadedness
Increased heart rate and breathing
Kidney Failure

Dysentery is a serious condition that can develop from exposure to Shigella or parasites. It usually causes bloody stool, fever, and extreme dehydration. It can be fatal if it's left untreated. In addition to being picked up from contaminated food or water, the bacteria or parasites that cause dysentery can be passed from person to person in close contact, or you can get it by swimming in unclean water.

Treatment for Traveler's Diarrhea

Getting sick while far from home is more than just inconvenient. The sudden onset and severity of symptoms can be frightening. Often, symptoms will last a few days and resolve on their own, but you may need to manage the condition and take medication.

Fluid Replacement

To manage dehydration, you want to concentrate on getting enough liquids even if you feel like you don't want to put anything in your stomach.

Drinking any safe fluids can manage mild cases of traveler's diarrhea. Since tap water may be a source of infection, you need to boil non-bottled water and let it cool before you drink it. You can also drink boiled broth or prepackaged (non-citrus) fruit juice. Sports drinks like Gatorade are good, too, but not essential.

For severe dehydration, an oral rehydration solution may be needed. These are mixes or packaged beverages that contain glucose and electrolytes such as potassium and sodium. Pedialyte is an example of an oral rehydration solution for kids.

Sweating can cause dehydration as well. Try to find a cool place out of the sun to rest while you rehydrate.

Antibiotics

Antibiotics may be used for traveler's diarrhea caused by bacterial infections. A stool test should be done to identify which antibiotic might work best.

Quinolone antibiotics such as Cipro (ciprofloxacin) are most often used when antibiotics are needed.

A single dose of 750 milligrams (mg) for adults is the typical treatment. Children may be given 20 to 30 mg per kilogram of weight per day.

In some areas, bacteria are resistant to quinolones, which means the medication won't help. This is especially a problem in Southeast Asia. Another antibiotic, azithromycin , may also be used in this case, although some strains are resistant to it.

Upset Stomach Medication

Pepto-Bismol can provide short-term relief of symptoms. However, it may not be effective in small doses, and high doses put you at risk for a health condition called salicylate toxicity. Additionally, Pepto-Bismol is not recommended for people younger than 18 years because there's a risk of a condition called Reye's syndrome .

Antidiarrheal Agents

It might seem logical to reach for an anti-diarrheal product such as Imodium (loperamide) or Lomotil (diphenoxylate). However, these products should not be used if your diarrhea is related to dysentery or if you see any signs of blood in your stools.

An antidiarrheal agent should only be taken with an antibiotic. When using an antidiarrheal for traveler's diarrhea, it is especially important to keep yourself well-hydrated. Discontinue the product if your symptoms worsen or you still have diarrhea after two days.

How Long Traveler's Diarrhea Lasts

Most cases of traveler's diarrhea last from one to five days. However, symptoms may linger for several weeks.

To help prevent traveler's diarrhea:

Wash your hands with soap and water after going to the bathroom and before eating.
At restaurants, only eat foods that are cooked and served hot.
Drink beverages from factory-sealed bottles or containers.
Don't get ice in your drink since it may be made with contaminated water.

There is evidence that Pepto-Bismol may protect against traveler's diarrhea. Studies have shown a protection rate of about 60%. However, not everyone should take Pepto-Bismol, including those who are pregnant or are 18 years of age and younger.

Don't take antibiotics or antidiarrheal medicine like Pepto-Bismol as prophylaxis—that is, to prevent traveler's diarrhea— unless it's been recommended to you by your healthcare provider.

Bacteria and viruses can live in water and food. These pathogens (germs) are most common in areas where the climate is warm, refrigeration is unreliable, and there isn't proper hand washing or bathroom sanitation. Infection with these pathogens (bacterial or viral) can cause traveler's diarrhea.

Traveler's diarrhea will often resolve on its own once the bacteria or virus is out of your system. However, you may need antibiotics. You may also need to manage symptoms by staying hydrated and using over-the-counter medications. You should contact your healthcare provider if symptoms last more than a few days.

When traveling to regions that have warm climates and relaxed hygiene practices, be sure to take steps to avoid eating or drinking anything that could have pathogens. Drink pre-packed or boiled water and ensure food is handled properly.

It's important to make sure that your child gets enough fluids. Diarrhea can lead to dehydration more quickly in kids than in adults. Check with your healthcare provider if your child has signs of dehydration such as dry mouth, few or no tears when crying, irritability, reduced urination, and drowsiness.

If you're pregnant, the most important thing to do is to drink enough fluids so you don't get dehydrated. Your doctor may suggest using azithromycin if you need an antibiotic. Don't use Pepto-Bismol (bismuth subsalicylate) when pregnant because of risks to the growing fetus.

Connor BA. Preparing international travelers: Travelers’ diarrhea . In: Brunette GW, ed. CDC Yellow Book 2020: Health information for international travel . Oxford University Press; 2017.

Leung AKC, Leung AAM, Wong AHC, Hon KL. Travelers’ diarrhea: a clinical review . Recent Pat Inflamm Allergy Drug Discov . 2019;13(1):38-48. doi:10.2174/1872213X13666190514105054

Shaheen NA, Alqahtani AA, Assiri H, Alkhodair R, Hussein MA. Public knowledge of dehydration and fluid intake practices: variation by participants' characteristics . BMC Public Health . 2018;18(1):1346. doi:10.1186/s12889-018-6252-5

Strachan SR, Morris LF. Management of severe dehydration . Pediatr Crit Care Med . 2017;18(3):251-255. doi:10.1177/1751143717693859

Riddle MS, Connor BA, Beeching NJ, et al. Guidelines for the prevention and treatment of travelers’ diarrhea: a graded expert panel report . J Travel Med . 2017;24(suppl_1):S57-S74. doi:10.1093/jtm/tax026

Johns Hopkins Medicine. Traveler's Diarrhea.

Nemours Foundation. KidsHealth. Staying healthy while you travel.

Morof DF, Carroll ID. Family travel: Pregnant travelers . In: Brunette GW, ed. CDC Yellow Book 2020: Health information for international travel . Oxford University Press; 2017.

Wanke, Christine A. " Travelers' Diarrhea ." UpToDate .

By Barbara Bolen, PhD Barbara Bolen, PhD, is a licensed clinical psychologist and health coach. She has written multiple books focused on living with irritable bowel syndrome.

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Traveller's diarrhoea

Peer reviewed by Dr Colin Tidy, MRCGP Last updated by Dr Toni Hazell Last updated 10 Feb 2023

Meets Patient’s editorial guidelines

In this series: Amoebiasis Giardia

Traveller's diarrhoea is diarrhoea that develops during, or shortly after, travel abroad. It is caused by consuming food and water, contaminated by germs (microbes) including bacteria, viruses and parasites. Other symptoms can include high temperature (fever), being sick (vomiting) and tummy (abdominal) pain. In most cases it causes a mild illness and symptoms clear within 3 to 4 days. Specific treatment is not usually needed but it is important to drink plenty of fluids to avoid lack of fluid in the body (dehydration). Always make sure that you get any advice that you need in plenty of time before your journey - some GPs offer travel advice but if yours doesn't then you may need to go to a private travel clinic.

What is traveller's diarrhoea, what causes traveller's diarrhoea, are all travellers at risk, what are the symptoms of traveller's diarrhoea, how is traveller's diarrhoea diagnosed, when should i seek medical advice for traveller's diarrhoea, how is traveller's diarrhoea in adults treated, how is traveller's diarrhoea in children treated, side-effects of traveller's diarrhoea, how long does traveller's diarrhoea last, how can i avoid traveller's diarrhoea.

Continue reading below

Traveller's diarrhoea is diarrhoea that develops during, or shortly after, travel abroad. Diarrhoea is defined as: 'loose or watery stools (faeces), usually at least three times in 24 hours.'

Traveller's diarrhoea is caused by eating food, or drinking water, containing certain germs (microbes) or their poisons (toxins). The types of germs which may be the cause include:

Bacteria: these are the most common microbes that cause traveller's diarrhoea. Common types of bacteria involved are:

Escherichia coli

Campylobacter

Viruses: these are the next most common, particularly norovirus and rotavirus.

Parasites: these are less common causes. Giardia, cryptosporidium and Entamoeba histolytica are examples of parasites that may cause traveller's diarrhoea.

Often the exact cause of traveller's diarrhoea is not found and studies have shown that in many people no specific microbe is identified despite testing (for example, of a stool (faeces) specimen).

See the separate leaflets called E. Coli (VTEC O157) , Campylobacter, Salmonella, Cryptosporidium , Amoebiasis (dysentery information), Shigella and Giardia for more specific details on each of the microbes mentioned above.

Note : this leaflet is about traveller's diarrhoea in general and how to help prevent it.

Traveller's diarrhoea most commonly affects people who are travelling from a developed country, such as the UK, to a developing country where sanitation and hygiene measures may not meet the same standards. It can affect as many as 2 to 6 in 10 travellers.

There is a different risk depending on whether you travel to high-risk areas or not:

High-risk areas : South and Southeast Asia, Central America, West and North Africa, South America, East Africa.

Medium-risk areas : Russia, China, Caribbean, South Africa.

Low-risk areas : North America, Western Europe, Australia and New Zealand.

Sometimes outbreaks of diarrhoea can occur in travellers staying in one hotel or, for example, those staying on a cruise ship. People travelling in more remote areas (for example, trekkers and campers) may also have limited access to medical care if they do become unwell.

By definition, diarrhoea is the main symptom. This can be watery and can sometimes contain blood. Other symptoms may include:

Crampy tummy (abdominal) pains.

Feeling sick (nausea).

Being sick (vomiting).

A high temperature (fever).

Symptoms are usually mild in most people and last for 3 to 4 days but they may last longer. Symptoms may be more severe in the very young, the elderly, and those with other health problems. Those whose immune systems are not working as well as normal are particularly likely to be more unwell. For example, people with untreated HIV infection, those on chemotherapy, those on long-term steroid treatment or those who are taking drugs which suppress their immune system, for example after a transplant or to treat an autoimmune condition

Despite the fact that symptoms are usually fairly mild, they can often mean that your travel itinerary is interrupted or may need to be altered.

Traveller's diarrhoea is usually diagnosed by the typical symptoms. As mentioned above, most people have mild symptoms and do not need to seek medical advice. However, in some cases medical advice is needed (see below).

If you do see a doctor, they may suggest that a sample of your stool (faeces) be tested. This will be sent to the laboratory to look for any microbes that may be causing your symptoms. Sometimes blood tests or other tests may be needed if you have more severe symptoms or develop any complications.

As mentioned above, most people with traveller's diarrhoea have relatively mild symptoms and can manage these themselves by resting and making sure that they drink plenty of fluids. However, you should seek medical advice in any of the following cases, or if any other symptoms occur that you are concerned about:

If you have a high temperature (fever).

If you have blood in your stools (faeces).

If it is difficult to get enough fluid because of severe symptoms: frequent or very watery stools or repeatedly being sick (vomiting).

If the diarrhoea lasts for more than 5-7 days.

If you are elderly or have an underlying health problem such as diabetes, inflammatory bowel disease, or kidney disease.

If you have a weakened immune system because of, for example, chemotherapy treatment, long-term steroid treatment, or HIV infection.

If you are pregnant.

If an affected child is under the age of 6 months.

If you develop any of the symptoms listed below that suggest you might have lack of fluid in your body (dehydration). If it is your child who is affected, there is a separate list for children.

Symptoms of dehydration in adults

Dizziness or light-headedness.

Muscle cramps.

Sunken eyes.

Passing less urine.

A dry mouth and tongue.

Becoming irritable.

Symptoms of severe dehydration in adults

Profound loss of energy or enthusiasm (apathy).

A fast heart rate

Producing very little urine.

Coma, which may occur.

Note : severe dehydration is a medical emergency and immediate medical attention is needed.

Symptoms of dehydration in children

Passing little urine.

A dry mouth.

A dry tongue and lips.

Fewer tears when crying.

Being irritable.

Having a lack of energy (being lethargic).

Symptoms of severe dehydration in children

Drowsiness.

Pale or mottled skin.

Cold hands or feet.

Very few wet nappies.

Fast (but often shallow) breathing.

Dehydration is more likely to occur in:

Babies under the age of 1 year (and particularly those under 6 months old). This is because babies don't need to lose much fluid to lose a significant proportion of their total body fluid.

Babies under the age of 1 year who were a low birth weight and who have not caught up with their weight.

A breastfed baby who has stopped being breastfed during their illness.

Any baby or child who does not drink much when they have a gut infection (gastroenteritis).

Any baby or child with severe diarrhoea and vomiting. (For example, if they have passed five or more diarrhoeal stools and/or vomited two or more times in the previous 24 hours.)

In most cases, specific treatment of traveller's diarrhoea is not needed. The most important thing is to make sure that you drink plenty of fluids to avoid lack of fluid in your body (dehydration).

Fluid replacement

As a rough guide, drink at least 200 mls after each watery stool (bout of diarrhoea).

This extra fluid is in addition to what you would normally drink. For example, an adult will normally drink about two litres a day but more in hot countries. The above '200 mls after each watery stool' is in addition to this usual amount that you would drink.

If you are sick (vomit), wait 5-10 minutes and then start drinking again but more slowly. For example, a sip every 2-3 minutes but making sure that your total intake is as described above.

You will need to drink even more if you are dehydrated. A doctor will advise on how much to drink if you are dehydrated.

Note : if you suspect that you are becoming dehydrated, you should seek medical advice.

For most adults, fluids drunk to keep hydrated should mainly be water. However, this needs to be safe drinking water - for example, bottled, or boiled and treated water. It is best not to have drinks that contain a lot of sugar, such as fizzy drinks, as they can sometimes make diarrhoea worse. Alcohol should also be avoided.

Rehydration drinks

Rehydration drinks may also be used. They are made from sachets that you can buy from pharmacies and may be a sensible thing to pack in your first aid kit when you travel. You add the contents of the sachet to water.

Home-made salt/sugar mixtures are used in developing countries if rehydration drinks are not available; however, they have to be made carefully, as too much salt can be dangerous. Rehydration drinks are cheap and readily available in the UK, and are the best treatment. Note that safe drinking water should be used to reconstitute oral rehydration salt sachets.

Antidiarrhoeal medication

Antidiarrhoeal medicines are not usually necessary or wise to take when you have traveller's diarrhoea. However you may want to use them if absolutely necessary - for example, if you will be unable to make regular trips to the toilet due to travelling.You can buy antidiarrhoeal medicines from pharmacies before you travel. The safest and most effective is loperamide.

The adult dose of this is two capsules at first. This is followed by one capsule after each time you pass some diarrhoea up to a maximum of eight capsules in 24 hours. It works by slowing down your gut's activity.

You should not take loperamide for longer than two days. You should also not use antidiarrhoeal medicines if you have a high temperature (fever) or bloody diarrhoea.

Eat as normally as possible

It used to be advised to 'starve' for a while if you had diarrhoea. However, now it is advised to eat small, light meals if you can. Be guided by your appetite. You may not feel like food and most adults can do without food for a few days. Eat as soon as you are able but don't stop drinking. If you do feel like eating, avoid fatty, spicy or heavy food. Plain foods such as bread and rice are good foods to try eating.

Antibiotic medicines

Most people with traveller's diarrhoea do not need treatment with antibiotic medicines. However, sometimes antibiotic treatment is advised. This may be because a specific germ (microbe) has been identified after testing of your stool (faeces) sample.

Fluids to prevent dehydration

You should encourage your child to drink plenty of fluids. The aim is to prevent lack of fluid in the body (dehydration). The fluid lost in their sick (vomit) and/or diarrhoea needs to be replaced. Your child should continue with their normal diet and usual drinks. In addition, they should also be encouraged to drink extra fluids. However, avoid fruit juices or fizzy drinks, as these can make diarrhoea worse.

Babies under 6 months old are at increased risk of dehydration. You should seek medical advice if they develop acute diarrhoea. Breast feeds or bottle feeds should be encouraged as normal. You may find that your baby's demand for feeds increases. You may also be advised to give extra fluids (either water or rehydration drinks) in between feeds.

If you are travelling to a destination at high risk for traveller's diarrhoea, you might want to consider buying oral rehydration sachets for children before you travel. These can provide a perfect balance of water, salts and sugar for them and can be used for fluid replacement. Remember that, as mentioned above, safe water is needed to reconstitute the sachets.

If your child vomits, wait 5-10 minutes and then start giving drinks again but more slowly (for example, a spoonful every 2-3 minutes). Use of a syringe can help in younger children who may not be able to take sips.

Note : if you suspect that your child is dehydrated, or is becoming dehydrated, you should seek medical advice urgently.

Fluids to treat dehydration

If your child is mildly dehydrated, this may be treated by giving them rehydration drinks. A doctor will advise about how much to give. This can depend on the age and the weight of your child. If you are breastfeeding, you should continue with this during this time. It is important that your child be rehydrated before they have any solid food.

Sometimes a child may need to be admitted to hospital for treatment if they are dehydrated. Treatment in hospital usually involves giving rehydration solution via a special tube called a 'nasogastric tube'. This tube passes through your child's nose, down their throat and directly into their stomach. An alternative treatment is with fluids given directly into a vein (intravenous fluids).

Eat as normally as possible once any dehydration has been treated

Correcting any dehydration is the first priority. However, if your child is not dehydrated (most cases), or once any dehydration has been corrected, then encourage your child to have their normal diet. Do not 'starve' a child with infectious diarrhoea. This used to be advised but is now known to be wrong. So:

Breastfed babies should continue to be breastfed if they will take it. This will usually be in addition to extra rehydration drinks (described above).

Bottle-fed babies should be fed with their normal full-strength feeds if they will take it. Again, this will usually be in addition to extra rehydration drinks (described above). Do not water down the formula, or make it up with less water than usual. This can make a baby very ill.

Older children - offer them some food every now and then. However, if he or she does not want to eat, that is fine. Drinks are the most important consideration and food can wait until the appetite returns.

Loperamide is not recommended for children with diarrhoea. There are concerns that it may cause a blockage of the gut (intestinal obstruction) in children with diarrhoea.

Most children with traveller's diarrhoea do not need treatment with antibiotics. However, for the same reasons as discussed for adults above, antibiotic treatment may sometimes be advised in certain cases.

Most people have mild illness and complications of traveller's diarrhoea are rare. However, if complications do occur, they can include the following:

Salt (electrolyte) imbalance and dehydration .

This is the most common complication. It occurs if the salts and water that are lost in your stools (faeces), or when you are sick (vomit), are not replaced by you drinking adequate fluids. If you can manage to drink plenty of fluids then dehydration is unlikely to occur, or is only likely to be mild and will soon recover as you drink.

Severe dehydration can lead to a drop in your blood pressure. This can cause reduced blood flow to your vital organs. If dehydration is not treated, your kidneys may be damaged . Some people who become severely dehydrated need a 'drip' of fluid directly into a vein. This requires admission to hospital. People who are elderly or pregnant are more at risk of dehydration.

Reactive complications

Rarely, other parts of your body can 'react' to an infection that occurs in your gut. This can cause symptoms such as joint inflammation (arthritis), skin inflammation and eye inflammation (either conjunctivitis or uveitis). Reactive complications are uncommon if you have a virus causing traveller's diarrhoea.

Spread of infection

The infection can spread to other parts of your body such as your bones, joints, or the meninges that surround your brain and spinal cord. This is rare. If it does occur, it is more likely if diarrhoea is caused by salmonella infection.

Irritable bowel syndrome is sometimes triggered by a bout of traveller's diarrhoea.

Lactose intolerance

Lactose intolerance can sometimes occur for a period of time after traveller's diarrhoea. It is known as 'secondary' or 'acquired' lactose intolerance. Your gut (intestinal) lining can be damaged by the episode of diarrhoea. This leads to lack of a substance (enzyme) called lactase that is needed to help your body digest the milk sugar lactose.

Lactose intolerance leads to bloating, tummy (abdominal) pain, wind and watery stools after drinking milk. The condition gets better when the infection is over and the intestinal lining heals. It is more common in children.

Haemolytic uraemic syndrome

Usually associated with traveller's diarrhoea caused by a certain type of E. coli infection, haemolytic uraemic syndrome is a serious condition where there is anaemia, a low platelet count in the blood and kidney damage. It is more common in children. If recognised and treated, most people recover well.

Guillain-Barré syndrome

This condition may rarely be triggered by campylobacter infection, one of the causes of traveller's diarrhoea. It affects the nerves throughout your body and limbs, causing weakness and sensory problems. See the separate leaflet called Guillain-Barré syndrome for more details.

Reduced effectiveness of some medicines

During an episode of traveller's diarrhoea, certain medicines that you may be taking for other conditions or reasons may not be as effective. This is because the diarrhoea and/or being sick (vomiting) mean that reduced amounts of the medicines are taken up (absorbed) into your body.

Examples of such medicines are those for epilepsy, diabetes and contraception . Speak with your doctor or practice nurse before you travel if you are unsure of what to do if you are taking other medicines and develop diarrhoea.

As mentioned above, symptoms are usually short-lived and the illness is usually mild with most people making a full recovery within in few days. However, a few people with traveller's diarrhoea develop persistent (chronic) diarrhoea that can last for one month or more. It is also possible to have a second 'bout' of traveller's diarrhoea during the same trip. Having it once does not seem to protect you against future infection.

Avoid uncooked meat, shellfish or eggs. Avoid peeled fruit and vegetables (including salads).

Be careful about what you drink. Don't drink tap water, even as ice cubes.

Wash your hands regularly, especially before preparing food or eating.

Be careful where you swim. Contaminated water can cause traveller's diarrhoea.

Regular hand washing

You should ensure that you always wash your hands and dry them thoroughly; teach children to wash and dry theirs:

After going to the toilet (and after changing nappies or helping an older child to go to the toilet).

Before preparing or touching food or drinks.

Before eating.

Some antibacterial hand gel may be a good thing to take with you when you travel in case soap and hot water are not available.

Be careful about what you eat and drink

When travelling to areas with poor sanitation, you should avoid food or drinking water that may contain germs (microbes) or their poisons (toxins). Avoid:

Fruit juices sold by street vendors.

Ice cream (unless it has been made from safe water).

Shellfish (for example, mussels, oysters, clams) and uncooked seafood.

Raw or undercooked meat.

Fruit that has already been peeled or has a damaged skin.

Food that contains raw or uncooked eggs, such as mayonnaise or sauces.

Unpasteurised milk.

Drinking bottled water and fizzy drinks that are in sealed bottles or cans, tea, coffee and alcohol is thought to be safe. However, avoid ice cubes and non-bottled water in alcoholic drinks. Food should be cooked through thoroughly and be piping hot when served.

You should also be careful when eating food from markets, street vendors or buffets if you are uncertain about whether it has been kept hot or kept refrigerated. Fresh bread is usually safe, as is canned food or food in sealed packs.

Be careful where you swim

Swimming in contaminated water can also lead to traveller's diarrhoea. Try to avoid swallowing any water as you swim; teach children to do the same.

Obtain travel health advice before you travel

Always make sure that you visit your GP surgery or private travel clinic for health advice in plenty of time before your journey. Alternatively, the Fit for Travel website (see under Further Reading and References, below) provides travel health information for the public and gives specific information for different countries and high-risk destinations. This includes information about any vaccinations required, advice about food, water and personal hygiene precautions, etc.

There are no vaccines that prevent traveller's diarrhoea as a whole. However, there are some other vaccines that you may need for your travel, such as hepatitis A, typhoid, etc. You may also need to take malaria tablets depending on where you are travelling.

Antibiotics

Taking antibiotic medicines to prevent traveller's diarrhoea (antibiotic prophylaxis) is not generally recommended. This is because for most people, traveller's diarrhoea is mild and self-limiting. Also, antibiotics do not protect against nonbacterial causes of traveller's diarrhoea, such as viruses and parasites. Antibiotics may have side-effects and their unnecessary use may lead to problems with resistance to medicines.

Probiotics have some effect on traveller's diarrhoea and can shorten an attack by about one day. It is not known yet which type of probiotic or which dose, so there are no recommendations about using probiotics to prevent traveller's diarrhoea.

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Traveler’s Diarrhea

Diagnosis |
Treatment |
Prevention |
More Information |

Traveler’s diarrhea is an infection characterized by diarrhea, nausea, and vomiting that commonly occur in travelers to areas of the world with poor water purification.

Traveler's diarrhea can be caused by bacteria, parasites, or viruses.

Organisms that cause the disorder are usually acquired from food or water, especially in countries where the water supply may be inadequately treated.

Nausea, vomiting, abdominal cramping, and diarrhea can occur with any degree of severity.

The diagnosis is usually based on the doctor's evaluation, but sometimes stool is tested for organisms.

Treatment involves drinking plenty of safe fluids and sometimes taking antidiarrheal medications or antibiotics.

Preventive measures include drinking only bottled carbonated beverages, avoiding uncooked vegetables or fruits, not using ice cubes, and using bottled water to brush teeth.

(See also Overview of Gastroenteritis .)

Traveler’s diarrhea occurs mostly in countries where the water supply is inadequately treated.

Symptoms of Traveler’s Diarrhea

The following symptoms of traveler's diarrhea can occur in any combination and with any degree of severity:

Intestinal rumbling

Abdominal cramping

Most cases are mild and disappear without treatment within 3 to 5 days.

Diagnosis of Traveler’s Diarrhea

A doctor's evaluation

Rarely stool tests

Diagnostic tests are rarely needed, but sometimes stool samples are tested for bacteria, viruses, or parasites, typically in people who have fever, severe abdominal pain, and bloody diarrhea.

Treatment of Traveler’s Diarrhea

Medications that stop diarrhea (antidiarrheal medications)

Sometimes antibiotics or antiparasitic medications

Antibiotics are not necessary for mild traveler's diarrhea.

Antiparasitic medications are given if a parasite is identified in the stool.

Travelers are encouraged to seek medical care if they develop fever or blood in the stool.

Prevention of Traveler’s Diarrhea

Safe consumption of food and water

Travelers should drink only bottled carbonated beverages or beverages made with water that has been boiled. Even ice cubes should be made with water that has been boiled.

Buffets and fast food restaurants pose an increased risk of infection.

More Information

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

Centers for Disease Control and Prevention (CDC): Choose Safe Food and Drinks When Traveling

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Traveler's diarrhea

Medically reviewed by Drugs.com. Last updated on Jun 19, 2023.

What is Traveler's diarrhea?

Traveler's diarrhea is an infection of the intestines that affects up to 50% of people who visit the developing world. It comes from eating contaminated food or drinking contaminated water.

Traveler's diarrhea usually is caused by viruses (especially norovirus) and bacteria (most commonly E. coli or Campylobacter ). It also can be caused by parasites. The diarrhea is usually not serious and goes away without treatment. However, when diarrhea is very watery and occurs often, dehydration may occur. Dehydration is the biggest danger of traveler's diarrhea.

Most episodes of traveler's diarrhea occur in the first or second week of the trip. Symptoms vary depending on what organism causes the problem. People have at least three loose stools per day and often a lot more. They also may experience fatigue , decreased appetite, abdominal cramps, nausea , and vomiting . Usually there is no blood in the stool (feces).

People know they have traveler's diarrhea based on their symptoms. If symptoms last longer than five days or if you develop fever or severe abdominal pain, see a doctor. Your blood and stool may be tested for evidence of infection. In some cases, a doctor might be able to identify the infecting organism, which could lead to a specific treatment.

Expected duration

Traveler's diarrhea usually improves on its own within five days.

Many cases of traveler's diarrhea can be prevented. Keep the following rules in mind, even in expensive resorts and hotels:

Alcohol does not sterilize water, so be cautious about contaminated water (including ice) used in mixed drinks.
Carbonated beverages and bottled water are usually safe to drink, but don't use ice, which could be contaminated. Drink from the bottle with a straw, rather than out of a glass. The glass may have been washed with contaminated water.
Purify water by boiling it for at least three minutes or using a water purification system.
Hot coffee and tea usually are usually safe to drink, but be sure the water has been boiled.
Don't eat fruits and vegetables unless they can be peeled, and peel them yourself to make sure that they are not contaminated after they are peeled.
Avoid dairy products, unless you are sure they have been pasteurized, and avoid undercooked meat and fish.
Wash your hands with the cleanest water available, or disinfect them with alcohol wipes before eating.
You can decrease your chance of getting diarrhea by taking two tablets of bismuth subsalicylate ( Pepto-Bismol ) four times a day, although you shouldn't do this for more than three weeks.

Common side effects of bismuth subsalicylate include black stools and a temporary black discoloration of your tongue. If you develop ringing in the ears, stop taking the medication because you may be developing salicylate toxicity. Aspirin and bismuth subsalicylate contain the same active ingredient, so if you need to take aspirin for health reasons, limit the use of bismuth subsalicylate. If you are allergic to aspirin, are pregnant, or have a history of kidney disease, ulcers, or other bleeding disorders, consult your doctor before taking bismuth subsalicylate.

Do not take antibiotics to prevent diarrhea unless your doctor tells you to. Antibiotics can have side effects, including sensitivity to sun, allergic reactions, and vaginal yeast infections.

Dehydration is the biggest danger of traveler's diarrhea, so replacing fluids is extremely important. If you have mild diarrhea, drink broth and diluted fruit juice or sport drinks. Alternate salty and sweet beverages (such as tomato juice and fruit juice) to replace your body's electrolytes. Electrolytes are the charged particles that make up salt. Electrolytes such as sodium, potassium, chloride, calcium, and magnesium play a crucial role in many functions of your body's cells.

If you have severe diarrhea (more than five unformed stools a day), it's best to drink an oral rehydration solution to replace the electrolytes you're losing. Pharmacies in most countries carry these products, which can be mixed with clean drinking water. You also can make your own solution by adding a half-teaspoon of salt, a half-teaspoon of baking soda and 4 tablespoons of sugar to 1 liter of clean water.

Keep in mind that fruit juice, broth, and sports drinks do not contain the right concentration of electrolytes for this purpose.

In most cases, traveler's diarrhea ends within three to five days without antibiotic treatment. However, it is a good idea to get a prescription from your doctor, and bring the antibiotic medication with you in case you need it. The general advice is to take antibiotics if you develop moderate or severe symptoms, such as fever, more than four episodes of diarrhea per day, or blood or mucus in the stool.

If you develop milder symptoms, taking a single dose of antibiotic may lead to faster improvement of your symptoms.

Antimotility medications such as loperamide ( Imodium ) may help to decrease the frequency of bowel movements, but they cannot prevent diarrhea and they do not get rid of the infection. They are useful for long bus or car trips or other situations where access to a bathroom is unavailable or inconvenient. These drugs may actually prolong the duration of symptoms with certain bacterial infections.

Treatment options

The following list of medications are related to or used in the treatment of this condition.

ciprofloxacin
Pepto-Bismol

View more treatment options

When to call a professional

Get medical attention if traveler's diarrhea does not end within five days, or if you develop a high fever, bloody stool, or severe abdominal pain.

Traveler's diarrhea is inconvenient, but it is rarely serious. The most worrisome complication is severe dehydration.

Additional info

Centers for Disease Control and Prevention https://www.cdc.gov/travel/

Learn more about Traveler's diarrhea

Antibiotics 101
Medications for Traveler's Diarrhea

Care guides

Traveler's Diarrhea

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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Am Fam Physician. 2005;71(11):2095-2100

Patient Information: Seen related handout on traveler’s diarrhea , written by the author of this article.

Acute diarrhea affects millions of persons who travel to developing countries each year. Food and water contaminated with fecal matter are the main sources of infection. Bacteria such as enterotoxigenic Escherichia coli , enteroaggregative E. coli , Campylobacter, Salmonella, and Shigella are common causes of traveler’s diarrhea. Parasites and viruses are less common etiologies. Travel destination is the most significant risk factor for traveler’s diarrhea. The efficacy of pretravel counseling and dietary precautions in reducing the incidence of diarrhea is unproven. Empiric treatment of traveler’s diarrhea with antibiotics and loperamide is effective and often limits symptoms to one day. Rifaximin, a recently approved antibiotic, can be used for the treatment of traveler’s diarrhea in regions where noninvasive E. coli is the predominant pathogen. In areas where invasive organisms such as Campylobacter and Shigella are common, fluoroquinolones remain the drug of choice. Azithromycin is recommended in areas with quinolone-resistant Campylobacter and for the treatment of children and pregnant women.

Acute diarrhea is the most common illness among travelers. Up to 55 percent of persons who travel from developed countries to developing countries are affected. 1 , 2 A study 3 of Americans visiting developing countries found that 46 percent acquired diarrhea. The classic definition of traveler’s diarrhea is three or more unformed stools in 24 hours with at least one of the following symptoms: fever, nausea, vomiting, abdominal cramps, tenesmus, or bloody stools. Milder forms can present with fewer than three stools (e.g., an abrupt bout of watery diarrhea with abdominal cramps). Most cases occur within the first two weeks of travel and last about four days without treatment. 1 , 3 Although traveler’s diarrhea rarely is life threatening, it can result in significant morbidity; one in five travelers with diarrhea is bedridden for a day and more than one third have to alter their activities. 1 , 3

Destination is the most significant risk factor for developing traveler’s diarrhea. 1 – 4 Regions with the highest risk are Africa, South Asia, Latin America, and the Middle East. Travelers who are immunocompromised and those with lowered gastric acidity (e.g., patients taking histamineH 2 blockers or proton pump inhibitors) are more susceptible to traveler’s diarrhea. Recently, a genetic susceptibility has been demonstrated. 5 Younger age and adventurous travel increase the risk of developing traveler’s diarrhea, 3 , 6 but persons staying at luxury resorts or on cruise ships also are at risk. 7 , 8

Food and water contaminated with fecal matter are the main reservoirs for the pathogens that cause traveler’s diarrhea. Unsafe foods and beverages include salads, unpeeled fruits, raw or poorly cooked meats and seafood, unpasteurized dairy products, and tap water. Eating in restaurants increases the probability of contracting traveler’s diarrhea 6 and food from street vendors is particularly risky. 9 , 10 Cold sauces, salsas, and foods that are cooked and then reheated also are risky. 6 , 11

In contrast to the largely viral etiology of gastroenteritis in the United States, diarrhea acquired in developing countries is caused mainly by bacteria 1 , 4 , 6 , 12 ( Table 1 ) . Enterotoxigenic Escherichia coli is the pathogen most frequently isolated, but other types of E. coli such as enteroaggregative E. coli have been recognized as common causes of traveler’s diarrhea. 13 Invasive pathogens such as Campylobacter, Shigella, and non-typhoid Salmonella are relatively common depending on the region, while Aeromonas and non-cholera Vibrio species are encountered less frequently.

Protozoal parasites such as Giardia lamblia , Entamoeba histolytica , and Cyclospora cayetanensis are uncommon causes of traveler’s diarrhea, but increase in importance when diarrhea lasts for more than two weeks. 14 Parasites are diagnosed more frequently in returning travelers because of longer incubation periods (often one to two weeks) and because bacterial pathogens may have been treated with antibiotics. Rotavirus and noroviruses are infrequent causes of traveler’s diarrhea, although noroviruses have been responsible for outbreaks on cruise ships.

The prevalence of specific organisms varies with travel destination. 1 , 4 , 12 , 13 , 15 Available data suggest that E. coli is the predominant cause of traveler’s diarrhea in Latin America, the Caribbean, and Africa, while invasive pathogens are relatively uncommon. Enterotoxigenic E. coli and enteroaggregative E. coli may be responsible for up to 71 percent of cases of traveler’s diarrhea in Mexico. 13 In contrast, Campylobacter is a leading cause of traveler’s diarrhea in Thailand 15 – 17 and also is common in Nepal. 6 Regional variation also exists with parasitic causes of traveler’s diarrhea ( Table 2 ) . 12 , 13 For example, Cyclospora is endemic in Nepal, Peru, and Haiti.

Food poisoning is part of the differential diagnosis of traveler’s diarrhea. Gastroenteritis from preformed toxins (e.g., Staphylococcus aureus , Bacillus cereus ) is characterized by a short incubation period (one to six hours), and symptoms typically resolve within 24 hours. 18 Seafood ingestion syndromes such as diarrhetic shellfish poisoning, ciguatera poisoning, and scombroid poisoning also can cause diarrhea in travelers. These syndromes can be distinguished from traveler’s diarrhea by symptoms such as perioral numbness and reversal of temperature sensation (ciguatera poisoning) or flushing and warmth (scombroid poisoning). 19

Although travelers often are advised to “Boil it, cook it, peel it, or forget it,” data on the effectiveness of dietary precautions in preventing traveler’s diarrhea are inconclusive. 3 , 6 , 20 Many travelers find it difficult to adhere to dietary recommendations. 21 In a study 3 of American travelers, nearly one half developed diarrhea despite pretravel advice on avoidance measures; even persons who strictly followed dietary recommendations developed diarrhea. Avoiding high-risk foods and adventuresome eating behaviors may reduce the inoculum of ingested pathogens or prevent the development of other enteric diseases such as typhoid and hepatitis A and E.

Boiling is the best way to purify water. Iodination or chlorination is acceptable but does not kill Cryptosporidium or Cyclospora, and increased contact time is required to kill Giardia in cold or turbid water. 22 Filters with iodine resins generally are effective in purifying water, although it is uncertain whether the contact time with the resin is sufficient to kill viruses. Bottled water generally is safe if the cap and seal are intact.

DRUG PROPHYLAXIS

Antibiotic prophylaxis is not recommended by the Centers for Disease Control and Prevention (CDC) even for high-risk travelers because it can lead to drug-resistant organisms and may give travelers a false sense of security. Although antibiotic prophylaxis does not prevent viral or parasitic infection, some health care professionals believe that it may be an option for travelers who are at high risk of developing traveler’s diarrhea and related complications (e.g., immunocompromised persons). Prophylaxis with fluoroquinolones is up to 90 percent effective. 23 Rifaximin (Xifaxan) may prove to be the preferred antibiotic because it is not absorbed and is well tolerated, although data on its effectiveness for prophylaxis have not yet been published.

Bismuth subsalicylate (Pepto-Bismol) provides a rate of protection of about 60 percent against traveler’s diarrhea. 24 However, it is not recommended for persons taking anticoagulants or other salicylates. Because bismuth subsalicylate interferes with the absorption of doxycycline (Vibramycin), it should not be taken by travelers using doxycycline for malaria prophylaxis. Travelers should be warned about possible reversible side effects of bismuth subsalicylate, such as a black tongue, dark stools, and tinnitus.

Probiotics are a more natural approach to prophylaxis of traveler’s diarrhea. Probiotics colonize the gastrointestinal tract and theoretically prevent pathogenic organisms from infecting the gut. Studies 25 , 26 of Lactobacillus GG (Culturelle) have suggested protection rates of up to 47 percent. More studies are needed to confirm the efficacy of probiotic prophylaxis. Agents for the prophylaxis of traveler’s diarrhea are summarized in Table 3 .

Empiric Treatment

Counseling travelers about food precautions does not eliminate the risk of traveler’s diarrhea, and nonantibiotic prophylaxis requires frequent dosing to achieve only a modest reduction in risk. In addition, the traveler with diarrhea may have difficulty accessing medical care, the quality of care may be poor, and the quality of medications purchased abroad may be substandard. 27 However, because antibiotics reduce the duration and severity of traveler’s diarrhea and generally are well tolerated, 28 providing the traveler with the means for empiric self-treatment can effectively reduce morbidity from traveler’s diarrhea.

Waiting 24 hours to confirm the diagnosis of traveler’s diarrhea results in unnecessary discomfort and time away from activities. Therapy can be initiated after the first episode of “distressing” diarrhea (i.e., diarrhea that is uncomfortable or interferes with activities). 29 , 30 If symptoms resolve within 24 hours, no further treatment is necessary. 31 , 32 If diarrhea persists after one day, treatment should be continued for one or two more days. An algorithm for the treatment of traveler’s diarrhea is presented in Figure 1 . 33 , 34

Antibiotic selection is based on the likelihood that an invasive organism is present and on antibiotic resistance patterns. These factors are determined largely by travel destination. Although blood in the stool suggests invasive disease, fever is not a sensitive indicator of dysentery. Fluoroquinolones have been the drug of choice for traveler’s diarrhea in most parts of the world because of their efficacy against most enteropathogens. Rifaximin recently became available for the treatment of noninvasive diarrhea caused by E. coli . For persons traveling to destinations where noninvasive E. coli is the predominant pathogen (e.g., Mexico), rifaximin is a good choice. 35 , 36

In regions where invasive pathogens are responsible for a significant proportion of traveler’s diarrhea, quinolones should be used. Azithromycin (Zithromax) is recommended in places where quinoloneresistant Campylobacter is prevalent (e.g., Thailand). 15 , 16 Antibiotics used for the treatment of traveler’s diarrhea are listed in Table 4 . 16 , 32 , 37 Trimethoprim-sulfamethoxazole (Bactrim, Septra) and doxycycline are no longer recommended because of the development of widespread resistance. 12

Therapy that involves an antibiotic with loperamide (Imodium) often limits symptoms to one day. 38 , 39 Loperamide has antimotility and antisecretory effects and is taken as two 2–mg tablets after the first loose stool, followed by one tablet after each subsequent loose stool (maximum of 8 mg in 24 hours for two days). The use of loperamide in dysentery has been controversial because of concerns about prolonging illness, but it is now considered safe when combined with an antibiotic. 29 , 34 , 38 A conservative approach would be to use loperamide for dysentery only if combined with an antibiotic and if the traveler has a long trip or will have no toilet access.

Oral rehydration solutions generally are unnecessary in adults younger than 65 years. 40 However, all travelers with diarrhea should be encouraged to drink plenty of fluids and to replace lost electrolytes using foods such as salt crackers or broth.

Traveler’s Diarrhea in Infants, Children, and Pregnant Women

Traveler’s diarrhea is more common in young children than in adults, and they have a higher risk of dehydration and severe illness. 41 Parents should seek immediate medical attention if their child shows signs of moderate to severe dehydration, bloody diarrhea, a temperature higher than 39°C (102°F), or persistent vomiting. Few data exist on the treatment of diarrhea in children. The use of oral rehydration solutions is essential, and parents should include prepackaged packets (to be mixed with safe water) in their travel kits. These packets are available in camping stores in the United States or in pharmacies in other countries.

Because infants and toddlers normally can have three or more loose stools, an alternate definition of diarrhea in this age group is a twofold increase in the frequency of unformed stool. 37 Nursing infants should continue to breastfeed on demand, and infants and older children should be offered their usual food.

Fluoroquinolones are not approved by the U.S. Food and Drug Administration (FDA) for use in children, and rifaximin is approved only for children 12 years and older. Therefore, azithromycin is the drug of choice for most children with traveler’s diarrhea. 37 Another option is nalidixic acid (Neggram) in a dosage of 55 mg per kg per day divided into four doses, not to exceed 1 g in 24 hours. 37 Loperamide is approved for children older than two years, but should not be used in children with dysentery. Bismuth subsalicylate should be avoided for prophylaxis in children because of the possible risk of Reye’s syndrome.

Pregnant women may be at higher risk of traveler’s diarrhea than nonpregnant women because of lowered gastric acidity and increased gastrointestinal transit time. 42 Quinolones (FDA pregnancy category C) generally are not advised during pregnancy, but azithromycin (FDA pregnancy category B) is safe. Oral rehydration should be emphasized. Although rifaximin is not absorbed, the safety of this medication in pregnant women has not been established. Loperamide (FDA pregnancy category B) may be used, but bismuth subsalicylate (FDA pregnancy category D) should be avoided. Being careful with food and water is particularly important during pregnancy because infections such as listeriosis can cause miscarriage, and hepatitis E can result in maternal mortality.

Complications

Dehydration is the main complication of traveler’s diarrhea, especially in children and older adults. Because E. coli O157:H7 is a rare cause of traveler’s diarrhea, there is little risk of hemolyticuremic syndrome. Other complications include Guillain-Barré syndrome after Campylobacter enteritis, Reiter’s syndrome (especially in persons who are HLA-B27 positive), Clostridium difficile colitis after antibiotic use, and postinfectious irritable bowel. These conditions may appear after the traveler has returned home.

If diarrhea persists despite antibiotic treatment, medical attention should be sought. Parasitic causes should be suspected in travelers who return with prolonged diarrhea or who do not respond to antibiotics. For those traveling to remote areas for extended periods, it is reasonable to discuss empiric treatment of protozoal infections (e.g., metronidazole [Flagyl] 250 mg three times a day for five days or tinidazole [Fasigyn] in a single 2–g dose for Giardia). 43

Resources such as the Travelers’ Health section of the CDC Web site ( http://www.cdc.gov/travel/diarrhea.htm ) or commercial sites such as Travel Health Online ( http://www.tripprep.com ) can keep physicians up to date on the epidemiology and resistance patterns of traveler’s diarrhea. Better preventive and prophylactic strategies will be needed until newer antibiotics become available and the sanitation and hygiene in developing countries improve.

von Sonnenburg F, Tornieporth N, Waiyaki P, Lowe B, Peruski LF , DuPont HL, et al. Risk and aetiology of diarrhoea at various tourist destinations.. Lancet. 2000;356:133-4.

Castelli F, Pezzoli C, Tomasoni L. Epidemiology of travelers’ diarrhea.. J Travel Med. 2001;8(suppl 2):S26-S30.

Hill DR. Occurrence and self-treatment of diarrhea in a large cohort of Americans traveling to developing countries.. Am J Trop Med Hyg. 2000;62:585-9.

Steffen R, Sack RB. Epidemiology. In: Ericsson CD, DuPont HL, Steffen R, eds. Travelers’ diarrhea. Hamilton, Ont.: BC Decker, 2003:112–23.

Jiang ZD, Okhuysen PC, Guo DC, He R, King TM, DuPont HL, et al. Genetic susceptibility to enteroaggregative Escherichia coli diarrhea: polymorphism in the interleukin–8 promotor region.. J Infect Dis. 2003;188:506-11.

Hoge CW, Shlim DR, Echeverria P, Rajah R, Herrmann JE, Cross JH. Epidemiology of diarrhea among expatriate residents living in a highly endemic environment. JAMA. 1996;275:533-8.

Hardie RM, Wall PG, Gott P, Bardhan M, Bartlett LR. Infectious diarrhea in tourists staying in a resort hotel.. Emerg Infect Dis. 1999;5:168-71.

Daniels NA, Neimann J, Karpati A, Parashar UD, Greene KD, Wells JG, et al. Traveler’s diarrhea at sea: three outbreaks of waterborne enterotoxigenic Escherichia coli on cruise ships.. J Infect Dis. 2000;181:1491-5.

Ansdell VE, Ericsson CD. Prevention and empiric treatment of traveler’s diarrhea.. Med Clin North Am. 1999;83:945-73

Mensah P, Yeboah-Manu D, Owusu-Darko K, Ablordey A. Street foods in Accra, Ghana: how safe are they?. Bull World Health Organ. 2002;80:546-54.

Adachi JA, Mathewson JJ, Jiang ZD, Ericsson CD, DuPont HL. Enteric pathogens in Mexican sauces of popular restaurants in Guadalajara, Mexico, and Houston, Texas.. Ann Intern Med. 2002;136:884-7.

Jiang ZD, Lowe B, Verenkar MP, Ashley D, Steffen R, Tornieporth N, et al. Prevalence of enteric pathogens among international travelers with diarrhea acquired in Kenya (Mombasa), India (Goa), or Jamaica (Montego Bay).. J Infect Dis. 2002;185:497-502.

Adachi JA, Jiang ZD, Mathewson JJ, Verenkar MP, Thompson S, Martinez-Sandoval F, et al. Enteroaggregative Escherichia coli as a major etiologic agent in traveler’s diarrhea in 3 regions of the world.. Clin Infect Dis. 2001;32:1706-9.

Taylor DN, Houston R, Shlim DR, Bhaibulaya M, Ungar BL, Echeverria P. Etiology of diarrhea among travelers and foreign residents in Nepal.. JAMA. 1988;260:1245-8.

Kuschner RA, Trofa AF, Thomas RJ, Hoge CW, Pitarangsi C, Amato S, et al. Use of azithromycin for the treatment of Campylobacter enteritis in travelers to Thailand, an area where ciprofloxacin resistance is prevalent.. Clin Infect Dis. 1995;21:536-41.

Hoge CW, Gambel JM, Srijan A, Pitarangsi C, Echeverria P. Trends in antibiotic resistance among diarrheal pathogens isolated in Thailand over 15 years.. Clin Infect Dis. 1998;26:341-5.

Sanders JW, Isenbarger DW, Walz SE, Pang LW, Scott DA, Tamminga C, et al. An observational clinic-based study of diarrheal illness in deployed United States military personnel in Thailand: presentation and outcome of Campylobacter infection.. Am J Trop Med Hyg. 2002;67:533-8.

Tauxe RV, Swerdlow DL, Hughes JM. Foodborne disease. In: Mandell GL, Douglas RG, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett’s Principles and practice of infectious diseases. 5th ed. Philadelphia: Churchill Livingstone, 2000:1150–65.

Barbier HM, Diaz JH. Prevention and treatment of toxic seafoodborne diseases in travelers.. J Travel Med. 2003;10:29-37.

Kozicki M, Steffen R, Schar M. ‘Boil it, cook it, peel it or forget it’: does this rule prevent travellers’ diarrhoea?. Int J Epidemiol. 1985;14:169-72.

Mattila L, Siitonen A, Kyronseppa H, Simula II, Peltola H. Risk behavior for travelers’ diarrhea among Finnish travelers.. J Travel Med. 1995;2:77-84.

Backer H. Water disinfection for international and wilderness travelers.. Clin Infect Dis. 2002;34:355-64.

RendiWagner P, Kollaritsch H. Drug prophylaxis for travelers’ diarrhea.. Clin Infect Dis. 2002;34:628-33.

Steffen R, Heusser R, DuPont HL. Prevention of travelers’ diarrhea by nonantibiotic drugs.. Rev Infect Dis. 1986;8(suppl 2):S151-9.

Oksanen PJ, Salminen S, Saxelin M, Hamalainen P, Ihantola-Vormisto A, Muurasniemi-Isoviita L, et al. Prevention of travellers’ diarrhoea by Lactobacillus GG.. Ann Med. 1990;22:53-6.

Hilton E, Kolakowski P, Singer C, Smith M. Efficacy of Lactobacillus GG as a diarrheal preventive in travelers.. J Travel Med. 1997;4:41-3.

World Health Organization. Substandard and counterfeit medicines. Fact sheet no. 275, November 2003. Accessed online April 6, 2005, at: http://www.who.int/mediacentre/factsheets/2003/fs275 .

De Bruyn G, Hahn S, Borwick A. Antibiotic treatment for travellers’ diarrhoea.. Cochrane Database Syst Rev. 2005;;1:CD002242.

Shlim DR. Self diagnosis and treatment of traveler’s diarrhea. In: Keystone JS, Kozarsky PE, Freedman DO, Nothdurft HD, Connor BA, eds. Travel medicine. St. Louis: Mosby, 2003:201–4.

Ericsson CD. Travelers’ diarrhea: epidemiology, prevention, and self-treatment.. Infect Dis Clin North Am. 1998;12:285-303.

Salam I, Katelaris P, Leigh-Smith S, Farthing MJ. Randomised trial of singledose ciprofloxacin for travellers’ diarrhoea.. Lancet. 1994;344:1537-9.

Adachi JA, Ericsson CD, Jiang ZD, DuPont MW, Martinez-Sandoval F, Knirsch C, et al. Azithromycin found to be comparable to levofloxacin for the treatment of US travelers with acute diarrhea acquired in Mexico.. Clin Infect Dis. 2003;37:1165-71.

DuPont HL, Mattila L. Antimicrobial treatment: an algorithmic approach. In: Ericsson CD, DuPont HL, Steffen R, eds. Travelers’ diarrhea. Hamilton, Ont.: BC Decker, 2003:227–37.

Adachi JA, OstroskyZeichner L, DuPont HL, Ericsson CD. Empirical antimicrobial therapy for traveler’s diarrhea.. Clin Infect Dis. 2000;31:1079-83.

DuPont HL, Jiang ZD, Ericsson CD, Adachi JA, Mathewson JJ, DuPont MW, et al. Rifaximin versus ciprofloxacin for the treatment of traveler’s diarrhea: a randomized, double-blind clinical trial.. Clin Infect Dis. 2001;33:1807-15.

Steffen R, Sack DA, Riopel L, Jiang ZD, Sturchler M, Ericsson CD, et al. Therapy of travelers’ diarrhea with rifaximin on various continents.. Am J Gastroenterol. 2003;98:1073-8.

Stauffer WM, Konop RJ, Kamat D. Traveling with infants and young children. Part III: travelers’ diarrhea.. J Travel Med. 2002;9:141-50.

Murphy GS, Bodhidatta L, Echeverria P, Tansuphaswadikul S, Hoge CW, Imlarp S, et al. Ciprofloxacin and loperamide in the treatment of bacillary dysentery.. Ann Intern Med. 1993;118:582-6.

Taylor DN, Sanchez JL, Candler W, Thornton S, McQueen C, Echeverria P. Treatment of travelers’ diarrhea: ciprofloxacin plus loperamide compared with ciprofloxacin alone. A placebo-controlled randomized trial.. Ann Intern Med. 1991;114:731-4.

Caeiro JP, DuPont HL, Albrecht H, Ericsson CD. Oral rehydration therapy plus loperamide versus loperamide alone in the treatment of traveler’s diarrhea.. Clin Infect Dis. 1999;28:1286-9.

Pitzinger B, Steffen R, Tschopp A. Incidence and clinical features of traveler’s diarrhea in infants and children.. Pediatr Infect Dis J. 1991;10:719-23.

Samuel BU, Barry M. The pregnant traveler.. Infect Dis Clin North Am. 1998;12:325-54.

Drugs for parasitic infections. Med Lett Drugs Ther. 2004;46:1-12.

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Information on how to stay safe and healthy abroad. About us.

Disease Prevention Advice

Travellers' Diarrhoea

Introduction.

Recommendations

Overview of Disease

The illness.

Additional Preventative Measures

Vaccination

Travellers' diarrhoea is spread mainly through food and water but it can also spread from person to person. It is one of the commonest health problems experienced during travel.

Travellers' diarrhoea usually gets better in 3 to 5 days. Most cases are mild and do not need specific treatment.

For further information on self-treatment and when to seek medical help, see treatment section below.

Recommendations for Travellers

Preventing travellers' diarrhoea depends mainly upon you practising good hand hygiene and food and water precautions .

before eating and drinking
before and after preparing food, particularly raw meat
after using the toilet or changing nappies
after visiting food markets
after touching live animals
If you cannot wash your hands, use alcohol based sanitiser :

It might be necessary for you to use extra preventive measures in certain situations.

Travellers' diarrhoea is one of the most common health issues experienced during travel.

It can be caused by many different germs like bacteria (E.coli, Salmonella), viruses ( norovirus ) and parasites ( Giardia ). All these germs are spread through eating and drinking contaminated food and water, or using contaminated dishes and cutlery.

Loose poo can also be caused by a change in your diet such as eating oily or spicy foods.

Travellers’ diarrhoea is when you have 3 or more bouts of loose, watery poo in 24 hours.
Most cases are mild, but for some people it is severe.
Travellers' diarrhoea tends to happen in the first week of travel.
Symptoms last on average 3 to 5 days and usually get better without you needing specific treatment.

Mild travellers’ diarrhoea

Travellers’ diarrhoea is mild if:

episodes of diarrhoea are not that frequent, they don’t disrupt your activities and any other symptoms are mild

You will usually get better with rest and without specific treatment, but you should make sure you don’t become dehydrated .

Preventing dehydration

When you have diarrhoea, you can lose a lot of water from your body and become dehydrated. Young children can dehydrate quickly.

These can be bought in pharmacies and supermarkets.
All rehydrating drinks must be prepared using safe water .

Anti-diarrhoeal Medicine

If diarrhoea is disrupting your plans but is not severe, you can take medicines such as Loperamide (Imodium®) or diphenoxylate plus atropine (Lomotil®). These can help, particularly with tummy pains.

Please note:

these medicines are not recommended for use in children under 12 years of age
Imodium® does not work straight away – it might take 1 to 2 hours to help
taking too much of these medicines might make you constipated

If you develop the following symptoms you should not take anti-diarrhoeal medications and should instead seek medical advice:

blood or slime (mucous) in your diarrhoea
a high fever
severe pain in your stomach

Severe Travellers’ diarrhoea

You should seek medical attention if:

you cannot continue your normal activities and you have had more than 6 episodes of diarrhoea stools in a 24 hour period, OR
you have passed blood or mucous (slime) in your diarrhoea, OR
you keep vomiting, have a fever or severe tummy pain

You might need intravenous fluids to prevent you becoming dehydrated, or antibiotics if an infection is suspected.

Additional Preventive Measures

Tablets to prevent diarrhoea are not routinely recommended as their side effects may be worse than the diarrhoea.

Antibiotics are not routinely recommended to prevent travellers’ diarrhoea:

widespread use of antibiotics causes resistance to develop in germs, meaning that antibiotics no longer work. This is an increasing problem around the world.

Preventative antibiotics might be offered to some people with severe medical problems that could be made worse by diarrhoea or dehydration. If you feel you may require antibiotics for travel, you should discuss this with your GP or a travel health practitioner.

All antibiotics have side effects, and can interact with other medicines that you may be taking. You should always read the patient information leaflet that comes with the medicine.

Non-antibiotic medicines

Bismuth subsalicylate (Pepto-Bismol®, Pepti-calm®)
Can help to prevent travellers' diarrhoea.
Available in tablet (Pepto-bismol®) or liquid (Pepto-bismol® or Boots Pepti-calm®).
Can be bought in pharmacies.
Can cause blackening of your poo and tongue.
It may interact with other medicines and is not suitable for everyone.
You should check with the pharmacist if it is safe for you to take.
Always follow the dose instructions on the medicine packet.

Pre/Probiotics

Pre- and probiotics are not recommended for either prevention or treatment of travellers' diarrhoea. There is not yet any convincing evidence that they are effective.

No licensed vaccines are available in the UK against travellers' diarrhoea.

General Travel Health Advice

What To Know About Traveler's Diarrhea And Norovirus: Symptoms And Treatment

Last updated May 28, 2024
Difficulty Beginner

Category Travel

what is travelers diarrhea like norovirus

Are you planning on traveling soon? Whether you're embarking on a tropical getaway or a business trip, there's one thing you need to be prepared for: traveler's diarrhea and norovirus. These two common travel illnesses can quickly turn your vacation or journey into a nightmare. But don't worry, we're here to help you navigate these unpleasant ailments. In this article, we'll explain what traveler's diarrhea and norovirus are, the symptoms to watch out for, and the best treatments to alleviate your discomfort. So grab your notepad and get ready to learn everything you need to know to stay healthy on your travels.

What You'll Learn

Introduction to traveler's diarrhea and norovirus, symptoms of traveler's diarrhea and norovirus, causes and transmission of traveler's diarrhea and norovirus, treatment and prevention of traveler's diarrhea and norovirus.

When embarking on a journey, whether for work or pleasure, the last thing anyone wants to think about is getting sick. However, it is important to be aware of potential health risks, such as travelers diarrhea and norovirus, especially when traveling to regions with poor sanitation conditions.

Travelers diarrhea, also known as TD, is a common condition that affects many people traveling to developing countries. It is typically caused by consuming contaminated food or water, which in turn leads to an infection in the intestines.

Symptoms of Travelers Diarrhea

The symptoms of travelers diarrhea can vary from mild to severe, and typically include watery diarrhea, abdominal pain and cramping, nausea, and sometimes vomiting. In some cases, fever and bloody stools may also occur. The onset of symptoms usually happens within a few days of arrival at the destination and can last anywhere from a few days to a week.

Prevention of Travelers Diarrhea

Preventing travelers diarrhea begins with practicing good hygiene. Washing hands with soap and clean water before eating or preparing food, and after using the toilet, can help reduce the risk of infection. It is also important to avoid consuming tap water, ice cubes, and uncooked or undercooked foods. Bottled or boiled water, as well as thoroughly cooked meals, are safer options. Additionally, using alcohol-based hand sanitizers and avoiding close contact with individuals who are sick can further reduce the risk.

Treatment of Travelers Diarrhea

If you do develop travelers diarrhea, it is crucial to stay hydrated by drinking plenty of fluids, especially oral rehydration solutions that contain electrolytes. Over-the-counter medications, such as loperamide, can help alleviate the symptoms of diarrhea, but it is important to consult a healthcare professional before taking any medications, as they may not be suitable for everyone. In severe cases, or if there is an underlying medical condition, it is recommended to seek medical attention.

Norovirus is a highly contagious virus that causes gastroenteritis, an inflammation of the stomach and intestines. It is often referred to as the "stomach flu" or "winter vomiting bug" due to its characteristic symptoms.

Symptoms of Norovirus

The symptoms of norovirus infection include sudden onset of nausea, vomiting, watery diarrhea, abdominal pain, and sometimes fever. These symptoms can be quite severe and can lead to dehydration if not properly managed. The incubation period for norovirus is usually between 24 to 48 hours, and the illness typically lasts for 1 to 3 days.

Prevention of Norovirus

Preventing norovirus infection involves practicing good hygiene, similar to preventing travelers diarrhea. Regularly washing hands with soap and water for at least 20 seconds, especially before eating or preparing food, and after using the toilet, can help minimize the risk of infection. It is also important to disinfect contaminated surfaces and to avoid close contact with individuals who are sick. Additionally, if you are experiencing symptoms of norovirus, it is best to stay home and avoid preparing food for others.

Treatment of Norovirus

There is currently no specific treatment for norovirus infection. The main focus of treatment is to manage symptoms and prevent dehydration. Drinking plenty of fluids, especially oral rehydration solutions, is crucial in order to replace lost fluids and electrolytes. It is also important to rest and take over-the-counter medications, such as anti-diarrheal drugs, as recommended by a healthcare professional. In severe cases or if complications arise, medical attention may be necessary.

Travelers diarrhea and norovirus are common health risks that can occur while traveling, especially in regions with poor sanitation. By practicing good hygiene, avoiding contaminated food and water, and taking necessary precautions, the risk of infection can be significantly reduced. If symptoms occur, it is important to stay hydrated and seek medical attention if necessary. Remember, prevention and preparedness are key when it comes to ensuring a safe and healthy journey.

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Travelers diarrhea and norovirus are two common causes of gastrointestinal illness, especially when traveling to countries with poor sanitation and hygiene practices. While they share some similar symptoms, there are also key differences between the two.

Travelers diarrhea is caused by ingesting contaminated food or water, typically with bacteria such as E. coli, Salmonella, or Campylobacter. Norovirus, on the other hand, is a highly contagious viral infection that can be spread through direct contact with an infected person, consuming contaminated food or water, or touching contaminated surfaces.

Symptoms of travelers diarrhea usually start within a week of exposure and may include:

Diarrhea: The most notable symptom is watery and frequent bowel movements. The stool may also be loose and may contain mucus or blood in severe cases.
Abdominal cramps: The person may experience stomach pain and discomfort, often accompanied by bloating and gas.
Nausea and vomiting: Some individuals with travelers diarrhea may also feel nauseous and may vomit.
Fever: In some cases, a low-grade fever may be present.
Dehydration: Due to the frequent bowel movements and fluid loss, dehydration can occur. Signs of dehydration include thirst, dry mouth, decreased urine output, and dizziness.

Norovirus, on the other hand, presents with its own set of symptoms, which may include:

Diarrhea: The diarrhea caused by norovirus is often watery and can be explosive, leading to accidents and urgency.
Vomiting: Norovirus is known for causing sudden and severe vomiting, sometimes without warning.
Abdominal cramps: Like travelers diarrhea, norovirus can cause stomach pain and discomfort.
Nausea: Many individuals infected with norovirus experience intense and persistent nausea.
Fever: Although less common, a low-grade fever can occur with norovirus infection.
Body aches: Some people with norovirus may experience muscle aches and general discomfort.

It's important to note that both conditions can vary in severity and duration. Generally, travelers diarrhea tends to resolve on its own within a few days without any specific treatment, whereas norovirus symptoms may persist for a longer period, typically 1-3 days.

If you or someone you know experiences these symptoms while traveling or shortly after returning, it's essential to stay hydrated by drinking plenty of fluids with electrolytes, such as oral rehydration solutions or sports drinks. Avoiding certain foods and opting for a bland diet can also help ease the symptoms.

In severe cases or when symptoms worsen or persist, it's crucial to seek medical attention. Your healthcare provider may recommend specific medications to alleviate symptoms, such as anti-diarrheal drugs or, in rare cases, antibiotics for travelers diarrhea.

To prevent both travelers diarrhea and norovirus, practicing good hygiene is key. This includes frequent handwashing with soap and water, especially before eating or preparing food, and after using the restroom. It's also advisable to consume only purified or bottled water, avoid ice cubes, and opt for well-cooked foods while traveling.

By taking these precautions and being aware of the symptoms of travelers diarrhea and norovirus, you can minimize the risk of contracting these infections and ensure a healthier travel experience.

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Causes and Transmission of Travelers Diarrhea and Norovirus

Traveler's diarrhea and norovirus are two common illnesses that can ruin your vacation or business trip. Understanding the causes and transmission of these conditions is essential in order to prevent and manage them effectively.

Traveler's diarrhea is a gastrointestinal infection that typically occurs during or immediately after traveling to developing countries, particularly those in Latin America, Africa, the Middle East, and Asia. It is caused by ingesting contaminated food or water, usually due to poor sanitation and hygiene practices in these regions. The main culprits behind this condition are bacteria such as Escherichia coli (E. coli), Salmonella, Shigella, and Campylobacter. In some cases, parasites and viruses can also be responsible for traveler's diarrhea.

Norovirus, on the other hand, is a highly contagious virus that causes gastroenteritis. It is responsible for outbreaks of vomiting and diarrhea in various settings, including cruise ships, nursing homes, schools, and hospitals. Norovirus is transmitted through direct contact with an infected person, consuming contaminated food or water, or touching surfaces or objects that have the virus on them and then touching your mouth or nose. It can survive on surfaces for extended periods of time, making it easy to spread from person to person.

To prevent traveler's diarrhea and norovirus, it is crucial to follow these preventive measures:

Practice good hygiene: Wash your hands frequently and thoroughly with soap and water before eating, after using the restroom, and after touching surfaces in public places. If soap and water are unavailable, use an alcohol-based hand sanitizer with at least 60% alcohol.
Ensure the safety of food and water: Drink only bottled or boiled water, and avoid adding ice to your beverages unless it has been made from safe water sources. Avoid consuming raw or undercooked meat, seafood, and eggs. It is also advisable to peel fruits and vegetables yourself and avoid street vendors.
Be cautious with personal hygiene items: Do not share personal items such as towels, eating utensils, or toothbrushes with others.
Pay attention to your surroundings: Avoid contact with people who are sick, and be mindful of touching surfaces in public areas. Use disinfectant wipes to clean surfaces such as doorknobs, handles, and light switches.

If you do develop traveler's diarrhea or norovirus, there are steps you can take to manage the symptoms:

Stay hydrated: Drink plenty of fluids, such as water, clear broth, or oral rehydration solutions, to replace lost fluids and electrolytes.
Rest and keep a bland diet: Give your digestive system a break by sticking to easily digestible foods like plain rice, bananas, and toast. Avoid spicy, greasy, or high-fiber foods.
Seek medical attention if necessary: If your symptoms are severe, persistent, or accompanied by other concerning symptoms, consult a healthcare professional. They may prescribe antibiotics or other medications to manage your symptoms.

In conclusion, traveler's diarrhea and norovirus are common illnesses that can be prevented by practicing good hygiene, ensuring food and water safety, and being mindful of your surroundings. If you do fall ill, stay hydrated, rest, and seek medical attention if needed. By taking these precautions and being proactive, you can minimize your risk of contracting these unpleasant infections and enjoy a safe and healthy trip.

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Traveling to new and exotic destinations can be an exciting experience, but it also comes with the risk of encountering stomach issues such as travelers' diarrhea and norovirus. These two conditions can put a damper on your travel plans, but with the right treatment and prevention strategies, you can minimize their impact on your trip.

Travelers' diarrhea, also known as "Montezuma's Revenge" or "Delhi Belly," is a common ailment that affects many travelers. It is typically caused by consuming food or water contaminated with bacteria, parasites, or viruses. The symptoms of travelers' diarrhea can vary in severity but often include abdominal pain, bloating, frequent bowel movements, and loose or watery stools. In some cases, vomiting may also occur. The symptoms usually start within a few days of arriving at your destination and can last for several days.

Norovirus, on the other hand, is a highly contagious virus that is often responsible for outbreaks of gastrointestinal illness on cruise ships, in hotels, and other confined spaces. It can be transmitted through direct contact with an infected person, contaminated food or water, or touching contaminated surfaces. The symptoms of norovirus infection are similar to those of travelers' diarrhea and can include nausea, vomiting, diarrhea, stomach cramps, and low-grade fever. These symptoms typically appear within 12 to 48 hours after exposure and usually resolve within 1 to 3 days.

To treat travelers' diarrhea or norovirus, it is important to stay hydrated by drinking plenty of fluids such as water, clear broths, and electrolyte-rich drinks like sports drinks or oral rehydration solutions. Avoiding caffeine, alcohol, and carbonated drinks is advisable as they can worsen symptoms. Over-the-counter medications such as loperamide (Imodium) can help reduce diarrhea, but it is important to use them sparingly and only when necessary, as they can delay the elimination of the infectious agent from the body.

In severe cases or when symptoms persist for more than a few days, it is recommended to seek medical attention. A healthcare professional may prescribe antibiotics to treat bacterial causes of travelers' diarrhea, but they are not effective against viral causes like norovirus.

Prevention is key when it comes to travelers' diarrhea and norovirus. The following strategies can help reduce the risk of infection:

Practice good hand hygiene: Wash your hands frequently with soap and water for at least 20 seconds, especially before eating or preparing food, after using the restroom, and after touching surfaces that may be contaminated.
Drink safe water: When traveling to areas with unsafe tap water, stick to bottled water or use water purification methods such as boiling, filtering, or using water disinfectant tablets.
Eat safe food: Be cautious of raw or undercooked foods, especially seafood, meat, and eggs. Choose hot, freshly cooked foods and avoid raw fruits and vegetables that may have been washed with contaminated water.
Avoid street food and unhygienic food establishments: Opt for eating at reputable restaurants with good hygiene practices to minimize the risk of contamination.
Use alcohol-based hand sanitizers: Carry a travel-sized hand sanitizer containing at least 60% alcohol to use when soap and water are not available.
Avoid close contact with sick individuals: Norovirus can spread easily through person-to-person contact, so try to maintain a distance from individuals who are exhibiting symptoms of illness.

By following these preventive measures and being cautious of your food and water sources, you can greatly reduce the risk of contracting travelers' diarrhea or norovirus during your travels. However, if you do experience symptoms, it is important to take care of your health, stay hydrated, and seek medical attention if necessary. With proper treatment and prevention strategies, you can ensure that stomach issues don't ruin your travel plans.

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Frequently asked questions.

Travelers diarrhea is a gastrointestinal illness that typically occurs when individuals travel to countries with poor sanitation and hygiene practices. It is characterized by frequent watery stools, abdominal cramps, and nausea.

While both travelers diarrhea and norovirus are gastrointestinal illnesses, they are caused by different pathogens. Travelers diarrhea is commonly caused by bacterial infections, whereas norovirus is a viral infection that can be spread through contaminated food or water or close contact with an infected person.

The symptoms of travelers diarrhea typically include frequent loose or watery stools, abdominal cramps, nausea, vomiting, and sometimes fever. These symptoms can range from mild to severe and usually last for a few days to a week.

To prevent travelers diarrhea, it is important to practice good hygiene and avoid consuming contaminated food or water. This can be achieved by washing hands frequently, avoiding tap water and ice cubes, avoiding raw or undercooked foods, and opting for bottled water and thoroughly cooked meals. It is also recommended to get vaccinated against certain pathogens that commonly cause travelers diarrhea, such as Escherichia coli and Salmonella.

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Diarrhoea - adult's assessment: Scenario: Acute diarrhoea (less than 4 weeks)

Last revised in November 2023

Covers the primary care assessment, investigation, and referral of acute or persistent (less than 4 weeks' duration) diarrhoea in adults.

Scenario: Acute diarrhoea (less than 4 weeks)

From age 18 years onwards.

How should I assess a person with acute diarrhoea?

The onset of symptoms within 6 hours of contaminated food suggests a pre-formed toxin of either Bacillus cereus or Staphylococcus aureus as the cause.
More frequent stool passage suggests an infectious cause.
Watery stools are associated with non-invasive and toxin-producing pathogens.
Blood in the stool, which is usually seen with invasive pathogens or severe inflammation, e.g. ulcerative colitis.
Recent hospital treatment or antibiotic treatment. For more information, see the CKS topic on Diarrhoea - antibiotic associated .
Weight loss.
Evidence of dehydration.
Nocturnal symptoms — organic cause more likely.
Also ask about sexual history (particularly in men who have sex with men) to exclude sexually transmitted enteric infection.
Quantity and character of stools (watery, fatty, containing blood or mucus).
Fever — often seen with invasive pathogens e.g. Salmonella, Shigella, and Campylobacter , enteric viruses or a cytotoxic organism such as Clostridioides difficile .
Recent contact with a person with diarrhoea.
Exposure to possible sources of enteric infection (for example certain foodstuffs such as meat, shellfish, dairy, and eggs), having eaten meals out, or recent farm or petting zoo visits).
Travel abroad — increases the likelihood of infection. Ask about potential exposures such as raw milk or untreated water.
Being in a higher risk group such as food handlers, nursing home residents (greater risk of norovirus, Cryptosporidium, and Giardia ), and recently hospitalized people.
Any new drugs, especially antibiotics or laxatives. For examples, see the Causes section on Acute diarrhoea .
Stress or anxiety.
Abdominal pain, which is often present in inflammatory bowel disease, irritable bowel syndrome, and ischaemic colitis.
History of recent radiation treatment to the pelvis.
Factors increasing the risk of immunosuppression (for example, human immunodeficiency virus infection, long-term steroid use, or chemotherapy).
Any surgery or medical conditions (for example, endocrine disease) accounting for the diarrhoea.
Diet and use of alcohol or substances such as sorbitol.
Features indicating dehydration include increased pulse rate, reduced skin turgor, dryness of mucous membranes, delayed capillary refill time, decreased urine output, hypotension (check for postural changes), and altered mental status. For more detail, see Clinical features of dehydration .
Also consider underlying conditions that may increase the risk of complications.
Perform an abdominal examination to assess for pain or tenderness, distension, mass, increased or decreased bowel sounds, or liver enlargement.
Consider a rectal examination to assess for rectal tenderness, stool consistency, blood, mucus, and possible malignancy.
If acute causes have been excluded and the person has features suggestive of an early presentation of a chronic cause , see Scenario: Chronic diarrhoea (more than 4 weeks) .

Clinical features of dehydration

The following signs are observed in dehydration:

Anorexia, nausea.
Light-headedness.
Postural hypotension.
Usually no signs.
Apathy/tiredness.
Nausea/headache.
Muscle cramps.
Pinched face.
Dry tongue or sunken eyes.
Reduced skin elasticity.
Tachycardia.
Profound apathy.
Confusion, leading to coma.
Marked peripheral vasoconstriction.
Systolic blood pressure less than 90 mmHg.
Oliguria or anuria.

However, these signs and symptoms have been shown to have poor diagnostic accuracy (particularly in the elderly). Plasma or serum osmolality measurement is the gold standard for diagnosis, with a 90% sensitivity and 100% specificity for plasma osmolality.

[ Bunn, 2019 ; Lacey, 2019 ]

Basis for recommendation

These recommendations are based on the 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea [ Shane, 2017 ], the Centers for Disease Control Yellow book Travelers' Diarrhea [ CDC, 2023 ], the BMJ Best Practice guide Assessment of acute diarrhoea [ BMJ Best Practice, 2023a ], and the review articles Diarrhea [ Nemeth, 2022 ] and Bacterial Diarrhea [ Akhondi, 2023 ].

How should I investigate acute diarrhoea in primary care?

The person is systemically unwell; needs hospital admission and/or antibiotics.
There is blood or pus in the stool.
The person is immunocompromised.
The person has recently received antibiotics, a proton pump inhibitor (PPI) or been in hospital — also request specific testing for Clostridioides difficile . For more information, see the CKS topic on Diarrhoea - antibiotic associated .
Diarrhoea occurs after foreign travel — also request tests for ova, cysts, and parasites and state the countries visited on the form.
Amoebae, Giardia , or cryptosporidium are suspected, particularly if diarrhoea is persistent (2 weeks or more) or the person has travelled to an at-risk area.
There is a need to exclude infectious diarrhoea (for example, severe abdominal pain, exacerbation of inflammatory bowel disease, or irritable bowel syndrome).
Diarrhoea in high-risk people (for example food handlers, healthcare workers, elderly residents in care homes).
Suspected food poisoning (for example after a barbeque or restaurant meal or eating eggs, chicken, or shellfish).
Outbreaks of diarrhoea in the family or community, when isolating the organism, may help pinpoint the source of the outbreak.
Contacts of people infected with certain organisms, for example, Escherichia coli O157 or C. difficile , where there may be serious clinical sequelae to an infection.
Close household contacts of a person with a Giardia infection.
For more information on how to send a stool sample (such as what information to include), see Sending a stool sample .
See the section on Investigations in the Scenario: Chronic diarrhoea (more than 4 weeks) for advice on which blood tests to request.

Sending a stool sample

Send a single specimen (a quarter-full specimen pot is the minimum needed for routine microbiology investigation). Only send loose stools, as the laboratory will not examine formed stools.
If diarrhoea occurs after exotic travel abroad, is recurrent, or prolonged, request ova, cysts, and parasites and give details of travel. Send three specimens a minimum of 2 days apart (ova, cysts, and parasites are shed intermittently).
Clinical features (for example, fever; bloody stool; severe abdominal pain).
History of immunosuppression.
Food intake (for example, shellfish).
Recent foreign travel (specify countries).
Recent antibiotic therapy, proton pump inhibitor therapy, or hospitalization (suggestive of Clostridioides difficile infection).
Exposure to untreated water (suggestive of infection with protozoa).
Contact with other affected people or an outbreak.
Repeat specimens are usually unnecessary unless advised by a specialist (microbiologist or consultant in public health), or ova, cysts and parasites are suspected.
These recommendations are largely based on and extrapolated from UK Health Security Agency (UKHSA) guidance M anaging specific infectious diseases (gastroenteritis chapter) [ UKHSA, 2023 ], the BMJ Best Practice guide Assessment of acute diarrhoea [ BMJ Best Practice, 2023a ], the review articles Diarrhea [ Nemeth, 2022 ] and Bacterial Diarrhea [ Akhondi, 2023 ].

Considering blood tests

This recommendation is pragmatic and is based on what CKS considers to be good clinical practice.

When should I admit or refer a person with acute diarrhoea?

The person is vomiting and unable to retain oral fluids, or
They have features of severe dehydration or shock (for more information, see Clinical features of dehydration ).
Older age (people 60 years of age or older are more at risk of complications).
Home circumstances and level of support.
Bloody diarrhoea.
Abdominal pain and tenderness.
Coexisting medical conditions — immunodeficiency, lack of stomach acid, inflammatory bowel disease, valvular heart disease, diabetes mellitus, renal impairment, rheumatoid disease, systemic lupus erythematosus.
Drugs — immunosuppressants or systemic steroids, proton pump inhibitors, angiotensin-converting enzyme inhibitors, diuretics.
They are aged 40 and over with unexplained weight loss and abdominal pain, or
They are aged 50 and over with unexplained rectal bleeding, or
They are aged 60 and over with iron deficiency anaemia or changes in their bowel habit, or tests show occult blood in their faeces.
Adults have a rectal or abdominal mass.
Abdominal pain.
Change in bowel habits.
Iron-deficiency anaemia.
Refer if the diagnosis remains uncertain after a primary care assessment — if infection and the other common causes of acute diarrhoea have been excluded and it is suspected that an episode of acute diarrhoea is due to a chronic cause .

These recommendations are extrapolated from an expert consensus guideline The management of infective gastroenteritis in adults. A consensus statement by an expert panel convened by the British Society for the Study of Infection [ Farthing, 1996 ], the BMJ Best Practice guide Assessment of acute diarrhoea [ BMJ Best Practice, 2023a ] and the National Institute for Health and Care Excellence guideline Suspected cancer: recognition and referral [ NICE, 2023 ].

Referral if the diagnosis remains uncertain

CKS has based this recommendation on what it considers to be good clinical practice.

The content on the NICE Clinical Knowledge Summaries site (CKS) is the copyright of Clarity Informatics Limited (trading as Agilio Software Primary Care) . By using CKS, you agree to the licence set out in the CKS End User Licence Agreement .

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Identification
When To Seek Care

Loose stools—sometimes called diarrhea—are loose, watery bowel movements that occur frequently. Some of the most common causes of loose stools are infections, medication side effects, and travelers' diarrhea. Chronic conditions like Crohn’s disease, ulcerative colitis UC), irritable bowel syndrome (IBS), and celiac disease also cause loose stools.

Loose stools can be either acute or chronic, depending on the cause. Acute loose stools last two weeks or less, while loose stools that last 2-4 weeks are considered persistent diarrhea. Chronic diarrhea lasts four weeks or more.

Between 1-5% of adults have chronic diarrhea. Depending on the cause of your diarrhea, there are several ways to manage and treat symptoms. You can also take steps to prevent loose stools from occurring.

Design by Health

What Does Loose Stool Look Like?

Healthcare providers often use a chart known as the Bristol Stool Form Scale (BSFS) to evaluate stool consistency. This scale identifies seven types of bowel movements and contains three points that indicate loose stool.

These loose stool points are types 5-7. Type 5 contains soft blobs with clear-cut edges and is often passed easily due to its loose consistency. Type 6 contains fluffy pieces with ragged edges and is a mushy consistency. Type 7 is extremely loose or watery with no solid edges.

According to the Bristol Stool Scale, loose stool is considered diarrhea. When this occurs, you may also feel an urgent need to use the bathroom , cramping, stomach pain, and nausea. In more extreme cases, you may feel lightheaded and dizzy as well as have a fever and vomit.

Causes of Loose Stool

Having loose stool or experiencing diarrhea is a common symptom of many different conditions. Here are some of the more common causes of loose stool.

Three types of infections can cause loose stools: viral, bacterial, and parasitic. The norovirus and rotavirus are the two most common viruses responsible for loose stools, but viral gastroenteritis can also cause diarrhea.

Bacteria can enter your body through contaminated food and water resulting in a bacterial infection that causes loose stools. The bacteria most often responsible for these loose stools include E. coli, salmonella, campylobacter , and shigella.

Similarly, parasites can enter the body through contaminated food and water causing parasitic infections that lead to diarrhea. Parasites that most often affect people include cryptosporidium enteritis, entamoeba histolytica , and giardia lamblia.

Medication Side Effects

Several medications can cause you to pass loose stool—antibiotics being the most common. Some cancer medications and antacids can also lead to diarrhea.

Before starting a new medication, talk to a healthcare provider about its side effects. If loose stool is a possibility, ask your provider for ways to prevent this side effect. Also, remember that long-term use of certain medications or powerful antibiotics can cause gut changes, leading to chronic diarrhea known as Clostridioides difficile ( C. diff ) .

Travelers' Diarrhea

Traveling to developing countries can often lead to loose stools, especially if you eat contaminated food or drink water that contains bacteria or parasites. Viruses can also spread through food and water in some countries.

Typically, the diarrhea you get from traveling is acute, meaning it will not last more than two weeks. However, some parasites can take longer to get rid of.

Food Sensitivities and Allergies

People who have food sensitivities like lactose intolerance or gluten sensitivity may experience loose stools after consuming foods with lactose or gluten. Also, if you are allergic to certain foods, you can have loose stools if you consume those foods.

It's possible to have a fructose intolerance and an intolerance to sugar alcohols like sorbitol, mannitol, and xylitol—commonly found in many processed foods and drinks. If you have an allergy or intolerance, your healthcare provider may advise limiting or even eliminating the foods you are sensitive to for a short period to see if it helps reduce the number of loose stools you have.

Digestive Disorders and Conditions

Certain disorders or digestive conditions can be the underlying cause of loose stools. Common conditions that can cause chronic diarrhea include celiac disease , Crohn's disease, irritable bowel syndrome (IBS), small intestinal bacterial overgrowth (SIBO), and ulcerative colitis (UC).

Your healthcare provider may run several tests to determine if one of these conditions is the root cause of your chronic diarrhea.

When To See a Healthcare Provider

Although loose stool is not necessarily harmful, it can become problematic if it is ongoing and has the potential to lead to dehydration or malabsorption. Loose stool can signal an underlying medical condition that needs to be addressed. You should consider seeing a healthcare provider for loose stool if you are:

Passing loose stools for more than two days (for adults) or more than 24 hours (for children)
Showing signs of dehydration like dry mouth, excessive thirst, and dark urine
Experiencing severe pain in your stomach or rectum
Passing six or more loose stools in 24 hours
Having a fever of 102 degrees Fahrenheit or higher
Passing stools that contain blood or pus
Having black or tar-like stools

Treatments for Loose Stool

Treatments for loose stools often depend on the underlying cause. The treatment options may include over-the-counter (OTC) medications, prescription drugs, diet changes, and supplements.

Medications

Acute loose stools can typically be treated with OTC medications. A healthcare provider may suggest Imodium (loperamide) or Pepto-Bismol (bismuth subsalicylate).

If you have a bacterial or parasitic infection, your provider can prescribe antibiotics or other medications to help clear up the infection.

If your loose stools are caused by an underlying condition like UC, Crohn's disease , or IBS, your provider may prescribe certain medications as part of a treatment plan.

Dietary Changes

When a food allergy or food sensitivity is the cause of loose stools, your provider will likely advise limiting or removing the food from your diet for a short period to see if it relieves the symptom.

Changing your dietary pattern can also help you treat loose stools even if you have no sensitivities. To help combat diarrhea, healthcare providers often recommend the BRAT diet (bananas, rice, applesauce, and toast).

You should also drink plenty of fluids to prevent dehydration. Beverages with added electrolytes can help replenish the electrolytes you've lost from passing loose stools.

Supplements

Healthcare providers might recommend supplements for treating loose stools. Researchers are investigating the role that probiotics can play in the treatment of diarrhea. However, the effects and benefits of probiotics are still not fully understood. If you're interested in taking probiotics for diarrhea, talk to your healthcare provider about how much to take and for how long.

Research has also shown that taking zinc supplements for about 10-14 days can help reduce the duration of loose stools and decrease the likelihood of developing persistent diarrhea.

Other supplements that show promise for treating chronic diarrhea include:

Phosphatidylcholine
Lactoferrin
Palmitoylethanolamide (PEA)

In cases of chronic diarrhea, your provider may suggest taking supplemental vitamins and minerals to fill any nutritional gaps you may have due to the malabsorption that loose stools can cause. Taking fiber supplements can also help add bulk to your stool.

Certain types of diarrhea or loose stools are preventable—like traveler's diarrhea and rotavirus. However, you likely cannot completely avoid loose stool. Here are some tips for preventing or reducing your risk of diarrhea :

Wash your hands thoroughly with warm water and soap for 15-30 seconds after using the restroom or changing diapers, or when handling food
Make sure to clean, store, and prepare foods properly
Avoid tap water, unpasteurized milk or juice, raw fruits and vegetables, food from street vendors, and raw or undercooked meat, fish, or shellfish when traveling
Use bottled or purified water for brushing your teeth, drinking, and making ice cubes when traveling
Get your infant vaccinated against the rotavirus, ensuring they receive all the doses by the time they are 8 months old

A Quick Review

Loose stools, or diarrhea, are loose, watery bowel movements caused by viruses, food sensitivities, parasites, infections, medications, some digestive disorders, and more. They can be acute or chronic depending on the underlying cause.

You can treat diarrhea with medications, dietary changes, and possibly probiotics. See a healthcare provider if you have diarrhea for more than two days or pass more than six loose stools in a 24-hour period.

MedlinePlus. Diarrhea .

National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms and causes of diarrhea .

American College of Gastroenterology. Diarrheal diseases overview .

American Family Physician. Chronic diarrhea in adults: Evaluation and differential diagnosis .

Chumpitazi BP, Self MM, Czyzewski DI, Cejka S, Swank PR, Shulman RJ. Bristol Stool Form Scale reliability and agreement decreases when determining Rome III stool form designations . Neurogastroenterol Motil . 2016;28(3):443-448. doi:10.1111/nmo.12738

National Institute of Diabetes and Digestive and Kidney Diseases. Treatment for diarrhea .

Kanikowska A, Janisz S, Mańkowska-Wierzbicka D, Gabryel M, Dobrowolska A, Eder P. Management of adult patients with gastrointestinal symptoms from food hypersensitivity: Narrative Review . J Clin Med . 2022;11(24):7326. doi:10.3390/jcm11247326

Nemeth V, Pfleghaar N. Diarrhea . In: StatPearls . StatPearls Publishing; 2024.

Barffour MA, Hinnouho GM, Wessells KR, et al. Effects of therapeutic zinc supplementation for diarrhea and two preventive zinc supplementation regimens on the incidence and duration of diarrhea and acute respiratory tract infections in rural Laotian children: A randomized controlled trial . J Glob Health . 2020;10(1):010424. doi:10.7189/jogh.10.010424

Kiani AK, Bonetti G, Donato K, Bertelli M. Dietary supplements for intestinal inflammation . J Prev Med Hyg . 2022;63(2 Suppl 3):E214-E220. doi:10.15167/2421-4248/jpmh2022.63.2S3.2763

MedlinePlus. Fiber .

When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Traveler's diarrhea

Overview  
Theory  
Diagnosis  
Management  
Follow up  
Resources  

Traveler's diarrhea is a common problem among travelers to destinations with deficiencies in water, sanitation, and hygiene (WASH) infrastructure, 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 travelers.

Management is self-diagnosis while still traveling, followed by hydration, medications for symptom relief, and possibly, antibiotics. Antibiotic therapy is generally reserved for moderate to severe infections.

In healthy patients, resolution is typically within 3-5 days even without antibiotic treatment.

Traveler's diarrhea (TD) is defined as ≥3 unformed stools in 24 hours accompanied by at least one of the following: fever, nausea, vomiting, cramps, tenesmus, or bloody stools (dysentery) during a trip abroad, typically to a destination with deficiencies in water, sanitation, and hygiene (WASH) infrastructure. It is usually a benign, self-limited illness lasting 3-5 days.

History and exam

Key diagnostic factors.

diarrhea (with or without tenesmus), cramping, nausea, and vomiting
dysentery (blood and fever)
persistent diarrhea >14 days

Other diagnostic factors

diarrhea without illness

Risk factors

travel to a high-risk destination
age <30 years
proton-pump inhibitor use
travelers with prior residence in higher-risk destination visiting friends and relatives
travel during hot and wet seasons
deployed military populations
lack of caution in food and water selection

Diagnostic investigations

1st investigations to order.

stool culture and sensitivity
multipathogen molecular diagnostic (polymerase chain reaction)
protozoal stool antigens

Investigations to consider

stool ova and parasite exam
Clostridioides difficile stool toxin
colonoscopy, endoscopy, and biopsy
hematology, blood chemistries, serology

Treatment algorithm

Pretravel prophylaxis, pre-travel prophylaxis, nonpregnant adults: mild diarrhea, nonpregnant adults: moderate diarrhea, nonpregnant adults: severe diarrhea, contributors, daniel t. leung, md, msc.

Associate Professor

Division of Infectious Diseases

University of Utah School of Medicine

Salt Lake City

Disclosures

DTL receives authorship royalties from UpToDate, Inc, for a chapter on travel medicine. DTL is an author of upcoming chapters on traveler's diarrhea for the US CDC Yellow Book. DTL is the president-elect of the American Committee on Clinical Tropical Medicine and Travelers' Health - Clinical Group within the American Society of Tropical Medicine and Hygiene. DTL is an author of some of the references cited in this topic.

Jakrapun Pupaibool, MD, MS

JP declares that he has no competing interests.

Acknowledgements

Dr Daniel T. Leung and Dr Jakrapun Pupaibool would like to gratefully acknowledge Dr Mark Riddle and Professor Gregory Juckett, the previous contributor to this topic.

MR has given talks on the management of traveler's diarrhea for the International Society of Travel Medicine (ISTM), the CDC Foundation, the American College of Gastroenterology (ACG), and the American College of Preventive Medicine. MR has led the development of guidelines for traveler's diarrhea for the ISTM, the ACG, and the Department of Defense. This work has been unpaid but support for travel has been accepted. MR is employed with Pfizer Inc., and is working on their Lyme disease vaccine program. While this is not in conflict with traveler’s diarrhea, Pfizer also makes azithromycin, which is an antibiotic recommended for the treatment of traveler’s diarrhea. MR does not work in the area of Pfizer that develops, markets, or distributes azithromycin. MR is an author of several references cited in this topic. GJ declares that he has no competing interests.

Peer reviewers

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

Mayo Clinic

PF is an author of a reference cited in this topic.

Differentials

Food poisoning
Irritable bowel syndrome
Secondary disaccharidase (or other dietary) deficiency
CDC Yellow Book 2024: travelers' diarrhea
2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea

Patient leaflets

Diarrhea in adults

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Infection Control in Health Care
About Project Firstline
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Training and Educational Materials

What to know.

These resources were developed with healthcare workers, for healthcare workers – to ensure you receive infection control information you need and deserve in the learning format that’s best for you.

About these resources

Want to lead an infection control training for healthcare workers? Project Firstline has developed training resources that cater to all styles of learning, so healthcare leaders can train their team with content that is engaging and accessible.

Project Firstline's resources are easy to use and can be integrated into existing infection control training programs. Whether you have 5 minutes or 30 minutes, you can lead an effective infection control training with your team.

Spanish language available‎ / Disponibles en español ‎

Almost all materials are available in English and Spanish. Casi todos los materiales están disponibles en inglés y español.

Interactive scenarios / Recursos interactivos

Check your infection control knowledge and gain valuable feedback in real time with our interactive, educational infection control resources. When you know how to recognize infection risks and understand how to apply infection control solutions you can save patient’s lives. From hospitals, to outpatient settings, to nursing homes, Project Firstline has interactive resources to help you increase and test your infection control knowledge no matter your healthcare setting.

Scenarios in English

Diarrhea Dilemma

Fidgeting Felix gets an IV

Escenarios en español

El dilema de la diarrea

A Beto el inquieto le ponen una vía intravenosa

What's Wrong with These Pictures?

Emergency Room

Nurses Station

Outpatient Exam Room

¿Qué hay de malo en estas imágenes?

Sala de emergencias

Estación de enfermería

Sala ambulatoria

Where Germs Live in Healthcare

Infographics / Infografías

Skin / piel.

Skin Profile

Los microbios viven en la piel

Respiratory system / Sistema respiratorio

Respiratory System Profile

Los microbios pueden vivir en el sistema respiratorio

Infection Control Actions to stop the spread of viral respiratory infections like influenza, RSV, and COVID-19.

Infection Control Actions for Respiratory Viruses

Medidas de control de infecciones para virus respiratorios

Blood / Sangre

Blood Profile

Los microbios pueden vivir en la sangre

Gut / Intestino

Gut Profile

Los microbios pueden viven en los intestinos

Los microbios viven en los intestinos

Water and wet surfaces / Agua y superficies húmedas

Water and Wet Surfaces Profile

Los microbios viven en el agua y superficies humedas

Los microbios viven en el agua y en superficies húmedas

Dry surfaces / Superficies secas

Dry Surfaces Profile

Los microbios pueden vivir en las superficies secas

Dirt and dust / Suciedad y polvo

Dirt and Dust Profile

Los microbios pueden vivir en la suciedad

Devices / Dispositivos

Devices Profile

Los microbios pueden vivir en los dispositivos

How to read a disinfectant label / Cómo leer la etiqueta de un desinfectante

How to Read a Disinfectant Label

Cómo leer la etiqueta de un desinfectante

Infection control actions for respiratory viruses / Medidas de control infecciones

Medidas de control de infecciones

Micro-learns / Microaprendizajes

Use Project Firstline’s short, adaptable micro-learn training resources to educate your team on a variety of infection control topics. The micro-learns are a series of guided discussions that connect infection control concepts to immediate, practical value, so healthcare workers can recognize infection risks and take action to stop the spread of germs. Incorporate these quick, in-person trainings into your next team meeting or huddle.

Micro-Learns Blood: What should you do if you see blood?

Blood Micro-Learn

Microaprendizaje de sangre

Rash / Sarpullidos

Micro-Learns Rash: You don't always know which rashes are infectious.

Rash Micro-Learn

Microaprendizaje sobre sarpullidos

Cough and congestion / Tos y congestión

Micro-Learns Cough and Congestion: One patient can infect multiple people quickly.

Cough and Congestion Micro-Learn

Microaprendizaje sobre tos y congestión

Draining wound / Heridas que supuran

Micro-Learns Draining Wound: What to do when you see a patient with a draining wound

Draining Wound Micro-Learn

Microaprendizaje sobre heridas que supuran

Diarrhea / Diarrea

Diarrhea Micro-Learn

Microaprendizajes de control de infecciones

Microaprendizaje sobre diarrea

Training toolkits / Kits de herramientas para capacitaciones

Use Project Firstline’s training toolkits to lead live, web-based training sessions with groups of healthcare workers. Help your team learn to recognize infection risks throughout their workday by teaching them where germs live and how they spread. You don’t need to be an expert to lead an infection control training, as the resources in this toolkit will help you along the way.

Facilitator and participant resources

Project Firstline Facilitator Toolkit Guide

Session Feedback Form

Facilitator Self-Assessment Form

Recursos para facilitadores y participantes

Guía del kit de herramientas para el facilitador

Formulario de comentarios de la sesión en el kit de herramientas

Autoevaluación del moderador

Recognizing Risk Using Reservoirs

Session 1: what does it mean to recognize a risk.

Session Plan: Recognizing Risk

Recognizing Risk Training Toolkit - Session 1 – Slides

Participant Booklet: Recognizing Risk

Session 2: How Germs Make People Sick

Session Plan: How Germs Make People Sick

Recognizing Risk Training Toolkit - Session 2 – Slides

Participant Booklet: How Germs Make People Sick

Session 3: Recognizing Risk Using Reservoirs: A Review

Session Plan: Recognizing Risk Review

Recognizing Risk Training Toolkit - Session 3 – Slides

Participant Booklet: Recognizing Risk Review

Recursos para facilitadoras y participantes

Sesión 1: ¿qué significa identificar un riesgo.

Plan de la sesión: Cómo identificar los riesgos

Conjunto de diapositivas: Cómo identificar los riesgos

Folleto de participante: Cómo identificar los riesgos

Sesión 2: Cómo los microbios enferman a las personas

Plan de la sesión: Cómo los microbios enferman a las personas

Conjunto de diapositivas: Cómo los microbios enferman a las personas

Folleto de participante: Cómo los microbios enferman a las personas

Sesión 3: Identificación de los riesgos por medio de los reservorios: una revisión

Plan de la sesión: Repaso de cómo identificar los riesgos

Conjunto de diapositivas: Repaso de cómo identificar los riesgos

Folleto de participante: Repaso de cómo identificar los riesgos

Introduction to Reservoirs: Where Germs Live

Session 1: body reservoirs.

Participant Booklet: Body Reservoirs

Reservoirs Training Toolkit - Session 1 – Slides

Session 2: Healthcare Environment Reservoirs

Session Plan: Environment Reservoirs

Reservoirs Training Toolkit - Session 2 – Slides

Participant Booklet: Environment Reservoirs

Session 3: Body and Healthcare Environment Reservoirs: Synthesis

Reservoirs Training Toolkit - Session 3 – Slides

Participant Booklet: Reservoirs Synthesis

Introducción a los embalses: dónde viven los gérmenes

Sesión 1: reservorios en el cuerpo.

Plan de la sesión: Reservorios en el cuerpo

Conjunto de diapositivas: Reservorios en el cuerpo

Folleto de participante: Reservorios en el cuerpo

Sesión 2: Entorno de atención médica

Plan de la sesión: Reservorios en el entorno

Conjunto de diapositivas: Reservorios en el entorno

Folleto de participante: Reservorios en el entorno

Sesión 3: Reservorios en el cuerpo y en los entornos de atención médica Síntesis

Plan de la sesión: Síntesis sobre los reservorios

Conjunto de diapositivas: Síntesis sobre los reservorios

Folleto de participante: Síntesis sobre los reservorios

Factsheets / Hojas informativas

Antimicrobial resistance (english only / solo inglés).

Fight Antibiotic Resistance with Infection Control

Fight Antimicrobial Resistance with Infection Control

Respiratory viruses / Virus respiratorios

Infection Control for Respiratory Viruses

Ventilation in healthcare settings / Ventilación en entornos sanitarios

Ventilation in Healthcare Settings

La ventilación en los entornos de atención médica

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Rangers were overwhelmed, outplayed in game 4 heartbreaker.

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SUNRISE, Fla. — This was not the ending Blake Wheeler deserved but it surely was the end result that the Rangers earned.

You look at the score, 3-2 in overtime for the Puddy Tats with a pair of power-play goals including Sam Reinhart’s dagger at 1:12 with Wheeler in the box. You see that the other one was scored three seconds after the Blueshirts killed one off. It might strike you that the Blueshirts were able to pretty much hold their own against a desperate opponent.

You would be wrong.

Because after the first period that represented the Blueshirts’ best 20 minutes of the series if not the entire tournament, they caved. They were overwhelmed. They yielded a flurry of odd-man rushes against. They defended nearly the entire remaining 41 minutes, out-attempted 59-14 after the first period at five-on-five after holding a 15-12 edge in the first in which they took a 1-0 lead.

This was not about being mauled physically. This was about being outplayed dramatically.

“There are going to be those swings, we were obviously happy with our first period, but maintaining it, we know they’re going to come out desperate and we have to raise our level,” Jacob Trouba said. “The first period, we were more on our toes and then we were on our heels really for the rest of the game.

“We have to match that level going back to New York.”

It’s a best-of-three in this heavyweight Eastern fight to advance to the Cup final, with Game 5 coming up at the Garden on Thursday. Home ice will mean nothing if Artemi Panarin, Mika Zibanejad and Chris Kreider, specifically but not exclusively, cannot find more. It will mean nothing if the Rangers can’t reverse the special teams equation that is 5-2 for Florida.

Follow The Post’s coverage of the Rangers in the NHL playoffs

Rangers fall in overtime as Panthers even up conference final
Troublesome trend comes back to bite Rangers this time
Rangers star tosses Matthew Tkachuk’s mouthguard into the stands in wild Game 4 moment

We know that it is hard out there and that Zibanejad is going against bigger, stronger, more physically inclined opponents. But this was a particularly difficult night for No. 93, who only recorded a 15.15 attempts share when on the ice.

And it was No. 93 whose pass just inside the line to Wheeler was errant enough for the Panthers to make it a turnover that forced No. 17 to pull down Aleksander Barkov pretty much in alone. Adam Fox had a bad change, compounding the problem. It could have been a penalty shot. The Rangers would have likely preferred that given the level at which Igor Shesterkin displayed throughout.

Jack Roslovic and the Rangers now come back to New York in a 2-2 series.

Again, though, the Kreider-Zibanejad connection was stifled. Jack Roslovic opened the match on the BFF’s right side but was replaced early in the second by Kaapo Kakko with head coach Peter Laviolette doing some line juggling.

Moving the furniture around had little impact on the team’s performance. Panarin made a neat low-to-high pass to set up Vincent Trocheck for his eighth goal of the tournament to give the Rangers a 1-0 lead on the power play at 8:51, but that was pretty much it. I know it’s hard for Panarin, too, but No. 10 had only one shot on three attempts. He has eight shots on 22 attempts in the series. This just will not do.

And again, it’s hard, they’re playing a bigger, stronger team, but this is it. This is no-excuse territory. The Rangers need to step up and meet this challenge. They’ve overcome one obstacle after another but the Puddy Tats are a whole different animal.

Igor Shesterkin #31 of the New York Rangers defends the net against Carter Verhaeghe #23 of the Florida Panthers during the second period.

Get this. After four games, the Rangers have outscored the Panthers 7-5 at five-on-five. But Florida has a 5-2 edge on special teams. That’s a slice of upside-down cake if I’ve ever seen one.

One of the Blueshirts’ spiritual leaders, Wheeler was inserted in the lineup for his first game since the Feb. 15 match against Montreal in which he suffered a gruesome right leg injury. His rehab effort has been documented as inspirational and he played 9:18, primarily on a unit with Barclay Goodrow and Matt Rempe, who had his most impactful game of the playoffs and was justifiably rewarded by Laviolette with four shifts in the third period.

“It was a long road back and I thought he came in there and [his line] controlled the puck and had it in the offensive zone,” Laviolette said. “For his first game back in a while I thought he was good.”

Matt Rempe was back in the lineup for the Rangers.

The Rangers are in some disarray here. The Zibanejad line has been stifled. Panarin has not been productive. Special teams have become an issue.

They are “The Shesterkin Show” at the moment.

That’s not enough to get two more victories, let alone six.

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COMMENTS

Traveler's diarrhea
Traveler's diarrhea is a digestive tract disorder that commonly causes loose stools and stomach cramps. It's caused by eating contaminated food or drinking contaminated water. Fortunately, traveler's diarrhea usually isn't serious in most people — it's just unpleasant. When you visit a place where the climate or sanitary practices are ...
Travelers' Diarrhea
Treatment. Travelers' diarrhea (TD) is the most predictable travel-related illness. Attack rates range from 30%-70% of travelers during a 2-week period, depending on the destination and season of travel. Traditionally, TD was thought to be prevented by following simple dietary recommendations (e.g., "boil it, cook it, peel it, or forget ...
Traveler's Diarrhea: What It Is, Treatment & Causes
Traveler's diarrhea is the most common travel-related illness. It affects between 30% and 70% of travelers, depending on the destination and the season. ... Symptoms are considered "severe" if you have a fever, if you have more than three loose stools a day or if you have blood or mucus in your stools. People with compromised immune ...
Traveller's diarrhoea
Definition. Traveller's diarrhoea (TD) is defined as ≥3 unformed stools in 24 hours accompanied by at least one of the following: fever, nausea, vomiting, cramps, tenesmus, or bloody stools (dysentery) during a trip abroad, typically to a destination with deficiencies in water, sanitation, and hygiene (WASH) infrastructure.
Travelers Diarrhea
Travelers' diarrhea is a common ailment in persons traveling to resource-limited destinations overseas. Estimates indicate that it affects nearly 40% to 60% of travelers depending on the place they travel, and it is the most common travel-associated condition. Bacterial, viral, and parasitic infections can cause symptoms, though bacterial sources represent the most frequent etiology.
Travelers' Diarrhea
Travelers' Diarrhea. Travelers' diarrhea is the most common travel-related illness. It can occur anywhere, but the highest-risk destinations are in Asia (except for Japan and South Korea) as well as the Middle East, Africa, Mexico, and Central and South America. In otherwise healthy adults, diarrhea is rarely serious or life-threatening, but it ...
Traveler's Diarrhea
410-955-5000 Maryland. 855-695-4872 Outside of Maryland. +1-410-502-7683 International. Diarrhea is the term for bowel movements that are loose or watery. Traveler's diarrhea occurs within 10 days of travel to an area with poor public hygiene. It's the most common illness in travelers.
Traveler's Diarrhea
The following symptoms of traveler's diarrhea can occur in any combination and with any degree of severity: Nausea. Vomiting. Intestinal rumbling. Abdominal cramping. Diarrhea. Fever. These symptoms begin 12 to 72 hours after ingesting contaminated food or water. Vomiting, headache, and muscle pain are particularly common in infections caused ...
Travelers' diarrhea
Travelers' diarrhea (TD) is a stomach and intestinal infection. TD is defined as the passage of unformed stool (one or more by some definitions, ... vomiting, abdominal cramps, fever, or blood in stools, medical treatment should be sought. Such patients may benefit from antimicrobial therapy.
Traveler's Diarrhea
The typical symptoms of traveler's diarrhea include: Abrupt onset of diarrhea. Fever. Nausea and vomiting. Bloating. Urgent need to have a bowel movement. Malaise (weakness or discomfort ...
Best Traveler's Diarrhea Treatments for Symptom Relief
Antibiotics may be used for traveler's diarrhea caused by bacterial infections. A stool test should be done to identify which antibiotic might work best. Quinolone antibiotics such as Cipro (ciprofloxacin) are most often used when antibiotics are needed. A single dose of 750 milligrams (mg) for adults is the typical treatment.
Traveller's Diarrhoea
Traveller's diarrhoea. Traveller's diarrhoea is diarrhoea that develops during, or shortly after, travel abroad. It is caused by consuming food and water, contaminated by germs (microbes) including bacteria, viruses and parasites. Other symptoms can include high temperature (fever), being sick (vomiting) and tummy (abdominal) pain.
Travelers' Diarrhea: Symptoms, Causes, Treatment, More
Acute diarrhea is sudden loose and watery stools . There are different levels of travelers' diarrhea (i.e., mild, acute, and severe). At varying severities, those levels can include symptoms like ...
Diarrhoea
Travellers' diarrhoea is defined as passing three or more unformed stools in a 24-hour period with at least one additional symptom, such as abdominal pain or cramps, nausea, vomiting, fever, or blood in the stools. Bacterial infection is the most common cause and is thought to account for 80-90% of cases of travellers' diarrhoea. The clinical ...
Traveler's Diarrhea
Traveler's Diarrhea. Traveler's diarrhea is characterized by diarrhea, nausea, and vomiting that commonly occur in travelers to areas of the world with poor water purification. Traveler's diarrhea can be caused by bacteria, parasites, or viruses. Organisms that cause the disorder are usually acquired from food or water, especially in ...
Traveler's diarrhea Guide: Causes, Symptoms and Treatment Options
Traveler's diarrhea is an infection of the intestines that affects up to 50% of people who visit the developing world. It comes from eating contaminated food or drinking contaminated water. Traveler's diarrhea usually is caused by viruses (especially norovirus) and bacteria (most commonly E. coli or Campylobacter ).
Traveler's Diarrhea
Acute diarrhea is the most common illness among travelers. Up to 55 percent of persons who travel from developed countries to developing countries are affected. 1, 2 A study 3 of Americans ...
Travellers' Diarrhoea
The Illness. Travellers' diarrhoea is when you have 3 or more bouts of loose, watery poo in 24 hours. Most cases are mild, but for some people it is severe. Travellers' diarrhoea tends to happen in the first week of travel. Symptoms last on average 3 to 5 days and usually get better without you needing specific treatment.
What To Know About Traveler's Diarrhea And Norovirus: Symptoms And
Prevention of Travelers Diarrhea. Preventing travelers diarrhea begins with practicing good hygiene. Washing hands with soap and clean water before eating or preparing food, and after using the toilet, can help reduce the risk of infection. ... The stool may also be loose and may contain mucus or blood in severe cases. Abdominal cramps: The ...
PDF The returned traveller with diarrhoea
Causes of diarrhoea in travellers While the causes of infectious diarrhoea in travellers are many and varied (Table 1, 2) enterotoxigenic Escherichia coli (ETEC) are the cause in up to 80% of cases.6,7 Most cases of traveller's diarrhoea are mild and have a duration of about 3 days. It should be noted that typhoid and paratyphoid are
Scenario: Acute diarrhoea (less than 4 weeks)
Consider blood tests if infection and the other causes of acute diarrhoea have been excluded and it is suspected that an episode of acute diarrhoea is due to a chronic cause. See the section on Investigations in the Scenario: Chronic diarrhoea (more than 4 weeks) for advice on which blood tests to request.
Loose Stool: Causes and Treatment
Some of the most common causes of loose stools are infections, medication side effects, and travelers' diarrhea. Chronic conditions like Crohn's disease, ulcerative colitis UC), irritable bowel ...
Traveler's diarrhea
Definition. Traveler's diarrhea (TD) is defined as ≥3 unformed stools in 24 hours accompanied by at least one of the following: fever, nausea, vomiting, cramps, tenesmus, or bloody stools (dysentery) during a trip abroad, typically to a destination with deficiencies in water, sanitation, and hygiene (WASH) infrastructure.
Training and Educational Materials
Project Firstline's resources are easy to use and can be integrated into existing infection control training programs. Whether you have 5 minutes or 30 minutes, you can lead an effective infection control training with your team. Spanish language available‎ / Disponibles en español ‎. Almost all materials are available in English and Spanish.
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Antioxidants
Dampness-heat syndrome diarrhea (DHSD) is a common clinical disease with a high prevalence but still has no satisfactory therapeutic medicine, so the search for a safe and effective drug candidate is ongoing. This study aims to explore the efficacy and mechanisms of Lianweng granules (LWG) in the treatment of DHSD and to identify the blood transport components of LWG.

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