Travellers Diarrhea Treatment

Travelers diarrhea is a digestive tract disorder that usually causes a person to suffer from diarrhea, which is characterised by complaints of loose stools, abdominal cramps, body weakness and can cause fever in a person if diarrhoea is not treated immediately. And even worse, diarrhoea can cause shock to the sufferer.

Travelers diarrhea can be caused by unhygienic food or drinking contaminated or undercooked water. It is rare for travelling diarrhea to result in shock and loss of consciousness in most people, it is just unpleasant.

Signs and Symptoms

The signs and symptoms of diarrhea when travelling are:

• - The urge to defecate many times that cannot be endured or delayed which can sometimes be a day or more.

• - Stomach cramps.

• - Nausea.

• - Vomiting.

• - Headache.

• - Fever.

• - In some instances, diarrhea may be mixed with blood.

If the incidence of diarrhea while travelling lasts more than a few days, seek the nearest competent health facility immediately.

In general, diarrhea in adults will recover within 2-3 days. In children, the recovery time is usually longer, up to 5-7 days.

If the incidence of diarrhea while travelling lasts more than a few days, seek the nearest competent health facility immediately.

In general, diarrhea in adults will recover within 2-3 days. In children, the recovery time is usually longer, up to 5-7 days.

Common Causes of Travelers Diarrhea

The occurrence of Travelers diarrhea in a person can be caused by infectious agents such as bacteria, viruses or parasites. A person can get diarrhea usually from consuming food or water contaminated with organisms from faeces.

Indigenous people from high-risk countries not affected in the same way, because the indigenous people's bodies are used to being contaminated with the bacteria and have built up immunity to the bacteria.

When to see the doctor

Travellers diarrhea can usually be caused by bacteria, parasites or viruses. If you are an adult, still conscious and have no weakness in movement and walking. It is best to see a doctor immediately if :

• Diarrhea for more than two days accompanied by headache, abdominal pain, weakness and drooping.
• And dehydration and bloody stools.
• And suffering from a high fever of more than (39 C).

However, be careful if diarrhea occurs in children and pregnant women as travelling diarrhea can cause severe dehydration in a short period of time.

Immediately seek treatment at the nearest health facility or contact a doctor immediately if the following symptoms occur : Liquid or mushy stools, abdominal distension, nausea or vomiting, abdominal pain, weakness, fever and children's body accompanied by dry mouth or crying without tears, very drowsy, or unresponsive and reduced urine volume, including reduced wet nappies in infants.

If the diarrhea experienced by pregnant women is accompanied by other complaints, such as contractions, severe lower abdominal pain, fever, and dehydration. Immediately seek treatment from a competent gynaecologist.

Travellers Diarrhea Treatment

Travellers diarrhea may get better without any treatment. However, stay hydrated with safe fluids, such as bottled water or water with electrolytes such as oral rehydration solution. If your condition does not improve quickly, there are medications available that may help.

Anti-motility agents are Attapulgite and Zinc.

Attapulgite absorbs the bacteria or toxins that cause diarrhea and removes them with the faeces. It also helps to make the faeces more compact as they pass and reduces the frequency of bowel movements. Attapulgite may also help reduce fluid loss due to diarrhea and relieve abdominal cramps in people with diarrhea.

Zinc is used as adjunctive therapy in cases of diarrhea. Zinc can help to reduce episodes of diarrhea and to overcome zinc deficiency in the body.

Antibiotics. These can be taken when you have severe symptoms, including high fever or diarrhea mixed with blood or mucus in your stool, so your doctor will prescribe you antibiotics.

Recommended antibiotic dosages for treating travelers diarrhea in adults and children.

Diagnosing Travellers Diarrhea

Diagnosing travellers diarrhea can include a medical examination and travel history. It is also necessary to perform a physical examination for signs of dehydration. So, if the symptoms worsen or do not resolve on their own, it is necessary to conduct further examination by taking a stool sample and examining it in the laboratory to determine whether a person's diarrhea is caused by bacteria, viruses, or parasites.

Complications that can occur in a person with travellers diarrhea are :

• Severe dehydration and unconsciousness.
• Internal organ damage i.e. acute kidney failure.
• Hypovolemic Shock (the body loses a lot of fluid or blood).
• Hypokalemia (lack of potassium in the blood).
• Metabolic Acidosis (Lack of Bicarbonate in the blood).
• And Muscle Cramps (Magnesium deficiency in the blood).

Avoiding Dehydration

The occurrence of diarrhea in a person with travellers diarrhea can usually lead to complications, namely dehydration, so it is important to always keep the body well hydrated by drinking sugar-salt and glucose solutions (ORS) to restore fluids and electrolytes and increase absorption in the intestinal tract that has been wasted.

Doctor Recommendation :

• Avoid spicy food, oily food, fatty food, and lactose-containing food like milk, butter, cheese, cream, yoghurt, or ice cream
• Make sure to always eat clean and well cooked food
• Avoid raw food like fruit or vegetable salad
• Drink plenty of electrolyte water to prevent dehydration
• Take a bed rest and don't do any kind of heavy activity

In the clean container mix :

• One liter of safe water.
• Half s small spoon of salt ( 3.5 gms ).
• Four Big spoons ( or eight small spoons ) of sugar ( 40 gms ).
• Stir the salt and the sugar until they dissolve in the water.
• The solution is ready for drinking.

Questions to ask during a visit to the specialist by a travellers diarrhea patient are:

• Complaints of diarrhea since when?
• How many times a day is diarrhea?
• Is the diarrhea liquid only or with waste?
• Is there blood in the diarrhea?
• Is the diarrhea slimy or is the diarrhoea like washing rice?
• Is it accompanied by fever or feverishness?
• Is there dizziness and headache?
• Is there nausea and vomiting?
• Is there a complaint of shortness of breath?
• Is there a complaint of abdominal cramps?
• Does the body feel weak?

References :

1. Elsevier Point of Care. Clinical Overview: Traveler's diarrhea. https://www.clinicalkey.com. Accessed Oct. 17, 2024.
2. Mayo Clinic. Diakses 2021. Pusat Data Informasi Kementerian Kesehatan RI. Diakses 2021. Profil Kesehatan Indonesia Tahun 2019.
3. Mayo Clinic. Traveler's diarrhea. Available at : https://www.mayoclinic.org/diseases-conditions/travelers-diarrhea/symptoms-causes/syc-20352182. Accessed Jan. 18, 2025.
4. Connor BA. Travelers’ diarrhea. Available at : http://wwwnc.cdc.gov/travel/yellowbook/2012/chapter-2-the-pre-travel-consultation/travelers-diarrhea.htm. Accessed August 20, 2012.
5. World Health Organization. 2017. Diarrhoeal disease. WHO. Diakses 03 Mei 2025. Available from : http://www.who.int/newsroom/fact-sheets/detail/diarrhoeal-disease
6. Traveler’s Diarrhea CDC Yellow Book 2024. Available at : https://wwwnc.cdc.gov/travel/yellowbook/2024/preparing/travelers-diarrhea.
7. Juffrie Mohammad, Soeharto Sri Supar, Oswari Hanifah, Arief Sjamsul, Rosalina Ina, Mulyani Nenny Sri. Buku ajar gastroenterologi-hepatologi jilid 1. Jakarta 2010: Badan penerbit IDAI. Hal 87-118.
8. Setiati S. Buku Ajar Ilmu Penyakit Dalam FK UI jilid II. Edisi VI. Jakarta: InternaPublishing, 2015.
9. Simadibrata M, Daldiyono. Diare akut. In: Setiati S, Alwi I, Sudoyo AW, Simadibrata M, Setiyohadi B, Syam AF, editors. Buku ajar ilmu penyakit dalam. 6th ed. Jakarta: InternaPublishing; 2014. p. 1899–908.
10. Soemarsono H. Kolera. In: Setiati S, Alwi I, Sudoyo AW, Simadibrata M, Setiyohadi B, Syam AF, editors. Buku ajar ilmu penyakit dalam. 6th ed. Jakarta: InternaPublishing; 2014. p. 588–94.
11. World Health Organization. 2014. Integrated Management of Cildhood Illness: distance learning course. Module 4: Diarrhoea. Geneva.

Writer: dr. Jhon Trafolta Silitonga, AMF - General Practitioner & Chief Medical Officer Nusa Medica Clinic Gili Trawangan