Traveller’s diarrhoea

Question 1

Features

Answer 1

Invariably a self-limiting problem (1–3 d)

Other meal sharers affected → food poisoning

Consider dehydration, esp. in the elderly

Consider possibility of enteric fever

Question 2

Traveller’s diarrhoea

Answer 2

Symptoms are usually as above but very severe diarrhoea, esp. if

• associated with blood or mucus,
• may be a feature of a more serious bowel infection such as amoebiasis.

Most is caused by an E. coli,

• watery diarrhoea within 14 days of arrival in a foreign country.

It will respond to norfloxacin 400 mg (o) bd for 3 days.

Question 3

Persistent traveller’s diarrhoea

Answer 3

If there is a fever and blood or mucus in the stools, suspect amoebiasis.

Giardiasis is characterised by abdominal cramps, flatulence and bubbly foul-smelling diarrhoea.

Question 4

Principles of treatment of acute diarrhoea (adults)

Answer 4

Maintenance of hydration

Antiemetic injection (for severe vomiting):

• prochlorperazine IM, statim or
• metoclopramide IV, statim

Antidiarrhoeal preparations (avoid if possible):

—loperamide (Imodium), preferred

• 2 mg caps, 2 caps statim
• then 1 after each unformed stool
• max. 8 caps/d

Question 5

Dietary advice to patient

Answer 5

Keep to a modest normal diet and drink good amounts of clear fluids (until the diarrhoea settles) such as:

• water
• tea
• lemonade and
• yeast extract (e.g. Marmite)

Then eat low-fat foods, such as stewed apples, rice (boiled in water), soups, poultry, boiled potatoes, mashed vegetables, dry toast or bread, biscuits, most canned fruits, jam, honey, jelly, dried skim milk or condensed milk (reconstituted with water).

Avoid fatty foods, fried foods, spicy foods, raw vegetables, raw fruit (esp. with hard skins), Chinese food, wholegrain cereals and cigarette smoking.