GPAtlas🧭 When to suspect
Travellers' diarrhoea is defined as:
• Passing three or more unformed stools in 24 hours.
• Together with at least one additional symptom – abdominal cramps, nausea, vomiting, fever, or blood in the stool.
• Beginning during or shortly after travel to a region with poorer food and water hygiene.
It is the commonest illness affecting international travellers and ranges from a mild nuisance to a severe, dehydrating illness.
A bacterial cause accounts for 80–90% of cases, most often enterotoxigenic E. coli.
• Campylobacter (especially in South and South-East Asia), Salmonella and Shigella are also common.
• Viruses (notably norovirus) and protozoa (Giardia, particularly when symptoms are prolonged) make up the remainder.
• Most episodes are self-limiting over a few days.
In primary care, assess hydration, recognise invasive (dysenteric) features, and reserve antibiotics for the few who need them. Risk rises with the destination and with host factors.
| Risk level | Typical destinations | Pre-travel action |
|---|---|---|
| Low | Western Europe, USA, Canada, Japan, Australia, New Zealand | • Food and water hygiene advice • Self-management information |
| Intermediate | Southern Europe, Israel, South Africa, some Caribbean and Pacific islands | • Hygiene and safe-water advice • When to seek help |
| High | Africa, Latin America, the Middle East, most parts of Asia | • Emphasise hygiene • Consider a standby antibiotic only for remote travel or high-risk individuals |
Have a lower threshold in those with higher susceptibility: children under 6, the elderly, pregnancy, inflammatory bowel disease, immunosuppression, an ileostomy, and those on proton pump inhibitors (reduced gastric acid lowers the infective dose).
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