First of all Water

As a rule, travel-related diarrhoeas are self-limiting and pass in healthy persons without any complications. However, for special patient groups the severe loss of fluid and minerals can be dangerous. This applies to babies and infants, to pregnant women and older people as well as chronically ill persons. In the worst case a circulatory collapse or kidney failure may occur. Even if most of the diarrhoeal diseases subside without any additional problems, they are still an unpleasant disruption of the holiday and everyone would like to overcome the problem as quickly as possible.

The most important step to be taken in the case of (travel-related) diarrhoea is the oral rehydration. This will prevent possible complications arising from the loss of water. The oral dose of a glucose-electrolyte drinkable solution will replace the lost water, the electrolytes thus stabilising the circulatory system. The addition of glucose increases the sodium and water absorption.

In principle the same medication is used for travel-related diarrhoea as for the one caused by »domestic« viruses.

Loperamid inhibits the intestinal motility and fluid secretion. Due to the decelerated transport speed in the bowels the body has more time to absorb water and electrolytes resulting in a firmer stool. The initial dosage for adults is four milligrams and after that two milligrams after each loose bowel movement, up to a maximum of twelve milligrams per day. Without a medical examination, adults should not use Loperamid for more than two days, children under twelve years and pregnant as well as breastfeeding women should not take it at all.

Loperamid is available in various preparations. Fused tablets (lozenges) have the advantage that they can be easily taken when travelling. Another antidiarrhoeal is the secretion inhibitor Racecadotril. Its active metabolite Thiorphan blocks the degradation of endogenous enkephalins. These substances inhibit the secretion of water and electrolytes in the gastrointestinal tract. If their degradation is stopped, the excessive discharge of water and electrolytes in the intestines will also be prevented.

For adults the therapy starts with two hard capsules à 100 milligrams active ingredient, regardless of the time of day. One capsule each (a maximum of four capsules per day) is to be taken before the following (main) meals. From the second day of treatment onwards, the patient is to take one capsule each three times a day before the main meals, until the stool is firm again.

In the case of normal travel-related diarrhoea, antibiotics play no role. As a rule they will be only applied if the condition does not subside by itself. If the diarrhoea lasts longer than four days when travelling and if it is accompanied by pain, temperature or blood/pus in the stool, a visit to the doctor is a must.

Travellers can substantially reduce the risk of getting ill if they observe a few simple rules. At the start of any stay abroad, a few days of rest can help to allow the body to get used to the climate and, if applicable, the time change. Thorough hygiene in handling food and drinks but also washing hands regularly – not only after using the toilet – are some of the most important measures.

The old slogan, »boil it, cook it, peel it or forget it«, may be known to overseas travellers, but is not always followed. In practical terms this means that only well-done freshly cooked, roasted or fried food should be eaten, and that fruit and vegetables should be peeled before eating them. Travellers should completely forgo tap water, ice cubes as well as meals from street kitchens. For drinking, only boiled or filtered water, also used for coffee and tea, as well as packaged drinks must be used. As a prophylaxis, ATP and pharmacists can recommend probiotics for children, pregnant women, chronically ill persons and senior citizens who are travelling to distant countries. Although they only slightly reduce the risk of travel-related diarrhoea, they do mitigate the severity of the illness.

Vaccinations are only available for severe intestinal infections such as cholera and typhus. Following the vaccination recommendations, travellers should therefore let themselves be vaccinated before going on holiday.