How to avoid traveller’s diarrhoea

Eating and drinking

There are certain foods that are much more likely to cause a problem. You should avoid uncooked meat or seafood, shellfish and any food that contains raw or undercooked eggs such as mayonnaise or sauces. While the Food Standards Agency has put runny and raw eggs back on the menu in the UK for everyone, including pregnant women and the elderly, this only applies to British eggs stamped with the Lion brand. In other countries, raw eggs can carry a risk of salmonella. it's also really important to keep away from salads and peeled fruits, which may have become contaminated with bugs during the food preparation.

Be very careful when you’re eating out in restaurants as you’ve got no control over how the food has been prepared. Make sure the food has been cooked through thoroughly and is hot when it’s served.

You should also be very careful if you’re eating food from markets or street vendors, or a buffet. You shouldn’t eat any food if you are uncertain about whether it has been kept hot or kept refrigerated. Ice cream can also cause a problem unless it’s been made from safe water. It’s usually perfectly safe to eat canned food or food in sealed packs. And fresh bread is usually safe.

Drinks can also be a problem if you’re not careful. You should avoid drinking tap water, even when it’s frozen into ice cubes. You should also stay away from unpasteurised milk and any fruit juices sold by street vendors. It is usually safe to drink bottled water, fizzy drinks that are in sealed bottles or cans, tea, coffee or any alcohol drinks.

Hand washing

This is always really important whether you’re at home or on holiday. Always wash your hands regularly, especially before preparing food or eating, and after going to the toilet. Make sure you dry your hands thoroughly after washing them.

It may be a good idea to take antibacterial hand gel whenever you travel in case soap and hot water are not available.

Swimming

Be careful where you swim. Any contaminated water can cause traveller’s diarrhoea. Try to avoid swallowing any water when you swim. Even if you don’t think you’ve swallowed any water it’s still very difficult to stop small amounts of any contaminated water getting into your mouth.

Vaccinations

There are no vaccines that prevent traveller's diarrhoea but you should always check about vaccines when you travel abroad. That's because there are other infections you may need to prevent, such as hepatitis A or typhoid, depending on where you are going. You may also need to take malaria tablets when travelling to certain countries where malaria can be a problem.

Antibiotics

If you otherwise fit and well with no health concerns, antibiotics are not generally recommended for preventing traveller's diarrhoea.

Antibiotics are only effective against bacteria and bacterial infections aren’t the only cause of traveller’s diarrhoea. Antibiotics won’t stop infection with viruses or parasites. Antibiotics can also cause side-effects so on balance it's best for most people to avoid taking antibiotics if they’re just being used for preventing diarrhoea.

However, antibiotics may be a good idea for some people who are at high risk of becoming very unwell if they get traveller’s diarrhoea. For example, people whose immune system isn’t working properly such as if you have HIV infection, sickle cell disease or type 1 diabetes, or if you're being treated with chemotherapy medicines for cancer. If you have a condition affecting the bowel, such as Crohn’s disease or ulcerative colitis, or have an ileostomy or colostomy, then you may also be advised to take antibiotics to prevent traveller’s diarrhoea. Ciprofloxacin is the usual antibiotic that is used.

Probiotics

Probiotics are live bacteria and yeasts that are usually added to yoghurts or taken as food supplements. They are often described as containing 'friendly bacteria' because they can help restore the natural balance of bacteria in your bowel. Probiotics do have some effect on preventing traveller's diarrhoea and can shorten an attack by about one day. There are no specific recommendations about probiotics for traveller’s diarrhoea because it's not yet known exactly which type of probiotic or what doses are needed to be effective.

General travel advice

You should always get travel advice before you go abroad. You can either visit your GP surgery or travel clinic for health advice and any vaccinations if you need them. There are also a growing number of websites that provide good information about travelling abroad. One example for UK travellers is the Fit for Travel website, which gives specific information for different countries, including information about any vaccinations required, and advice about food, water and personal hygiene precautions.