How to avoid Traveller’s Diarrhea on your next holiday


Many of us are planning on getting on long haul flights over the coming weeks as the northern hemisphere summer holidays approach.

It’s worth noting that some people may be more susceptible to getting sick on planes because the cabin air humidity is under 20%, whereas average humidity in Singapore is over 80%.  The dry air exposure affects mucus, the immune system’s front line of defense, leaving people marginally more vulnerable to getting sick. A study in the Journal of Environmental Health Research found that people are far more likely — 113 times more, by one of the study’s measures — to catch the common cold during a flight than normal ground transmission.

Airplanes are known to be flying petri dishes and recent studies have shown that the dirtiest place on a plane is not the toilets but actually the tray table. Get your alcohol wipes out!

What is traveller’s diarrhea?

Traveller’s diarrhoea (TD) develops during, or shortly after, travel abroad and is caused by eating food, or drinking water, contaminated by germs. It is defined as loose or watery stools usually at least three times in 24 hours and can be accompanied by abdominal cramps, fever or vomiting.

It is the most frequent illness among persons travelling to developing countries (usually in the tropics and sub-tropics) affecting from 20-70% of travellers.

What causes traveller’s diarrhoea?

Bacteria such as Escherichia coli, Campylobacter, Salmonella or Shigella are the most common cause.  A small percentage of cases occur due to parasitic organisms such as giardia, but these infections appear mainly in travellers who spend extended periods in developing countries. Viruses are a major cause of diarrhoea in children but are responsible for only a minority of cases of TD.


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

  • Fever
  • Nausea or vomiting
  • Crampy abdominal pains

Symptoms are usually mild in most cases and last for 3 to 4 days, but they can last longer.

When should I seek medical help?

Seek medical help for traveller’s diarrhoea if:

  • Diarrhoea is severe, bloody, or does not resolve within a few days.
  • Diarrhoea is accompanied by fever and chills.

In more severe cases, treatment with antibiotics may be recommended.


Drink only sealed, bottled water and use this for brushing teeth also. If unsure whether water is safe to drink, boil it for at least a few minutes. Boiling is the only reliable way to purify water.

Eat only food that has been thoroughly cooked and is served steaming hot. Always wash your hands with soap and water before eating or preparing food.

Avoiding certain foods can reduce the risk of acquiring TD. These include:

  • Shellfish, prawns and raw meat.
  • Milk, ice cream and other dairy products unless made with pasteurised (or boiled) milk.
  • Uncooked leafy vegetables (e.g. salads). Only eat those fruit or vegetables that you can peel or cut open yourself.


Most episodes of TD are transient and do not require treatment. The most important point is to ensure drinking plenty of fluids to avoid dehydration. Oral rehydration solutions can be taken to treat and prevent dehydration. Dairy products, caffeine and alcohol should be avoided as these may worsen symptoms and cause dehydration.

Light carbohydrate-rich foods are tolerated best (i.e. rice, toast, potatoes and dry biscuits).

Imodium and Lomotil are antidiarrhoeal agents and do not eradicate the infective organisms. They have a role restricted to short-term control of diarrhoea symptoms and can also help with colicky abdominal pains. However overuse can cause rebound constipation and they are not recommended for use in children less than 12 years of age.

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 bacteria has been identified after testing of your stool sample.

Probiotics such as lactobacillus may be taken in conjunction with the antibiotic and have also shown to be effective as prophylaxis against TD.

Lastly, in travellers who are at increased risk of severe or complicated diarrhoea, immunoprophylaxis should be considered. The oral vaccination against cholera also has activity against ETEC. For infants there is a rotavirus vaccine available.

To protect against the worst symptoms consider getting a Traveller’s Medical Kit for IMC which carries some appropriate medicines. See:

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