Mild diarrhoea is one or two unformed bowel motions without any other symptoms over 24 hrs. Take two loperamide tablets straight away, and then one tablet after each loose bowel motion – up to a maximum of 8 in 24 hours.
Antibiotics have been proven to be effective for traveller’s diarrhoea.
However, a study of antibiotic use in traveller’s diarrhoea published in 2015 showed the potentially “bad” effect of antibiotics on bowel bacteria. Of 430 random travellers from Finland , 21% returned with resistant bacteria in their faeces. However, 37% of those who returned after a course of antibiotics for traveller’s diarrhoea were colonised with the same resistant bacteria.
Therefore, it is reasonable to hold off antibiotics until you need them. When diarrhoea persists more than 24 hrs, you may wish to start the antibiotic. Start antibiotics earlier if there are cramps, mucus or blood.
Azithromycin is the main antibiotic used for traveller’s diarrhoea. Take one tablet each day for up to 3 days. Stop the Azithromycin early if the diarrhoea has gone away. You may continue to take Loperamide during this time, but stop loperamide if you have a high fever with bloody diarrhoea.
When diarrhoea is moderate to severe to start with then you can start the Azithromycin straight away. As a guide, you can start the antibiotic after having at least 2 unformed bowel motions in 24 hrs with another symptom such as nausea, cramps, vomiting, or blood in the bowel motions.
A second-line antibiotic occasionally used is Tinidazole which covers less common causes of diarrhoea such as Giardia. Tinidazole is taken as four tablets in a single dose (in one go). You’d normally want to get a stool test done to identify the cause but this isn’t always possible.
Please read the information sheet that comes with the medication to check for any interactions or other issues such as children & Pregnancy.
Rifaximin (®Xifaxan) is another option for travellers. The dose is 200mg three times per day for three days. This antibiotic was approved in Australia in 2016 for Traveller’s diarrhoea.
Rifaximin is an attractive option because the antibiotic is not absorbed into the body. The downside is that Rifaximin is unlikely to be as effective against full-blown bacterial gastroenteritis as other antibiotics. For example, Rifaximin is not effective against Salmonella, Campylobacter or Shigella. Therefore, Rifaximin should not be used when there is severe illness, fever, or blood in the bowel motions.
Finally, don’t forget about rehydration. A recent study of gastroenteritis in young children showed that “Dilute apple juice is a good alternative to electrolytes for children with gastroenteritis.” The children in the study presented to an emergency department with gastroenteritis and had “minimal rehydration.” The children were age 6 months to 5 years and given either half strength apple juice or standard electrolytes.