How common is common
Something between a fifth and half of travellers to high-risk regions get it, usually in the first week. It is rarely dangerous in a healthy adult and it is reliably miserable: cramping, urgency, several days of a holiday spent near a bathroom.
The causes are mostly bacterial, with enterotoxigenic E. coli the single commonest, and some viral and parasitic. It arrives through food and water - salad washed in tap water, ice, a buffet that has been warm too long, fruit juice diluted from the tap.
What to pack, and what each thing is for
Rehydration salts are the one item nobody should travel without, and the one people most often leave out. Dehydration is what turns an unpleasant two days into a medical problem, particularly in children and older travellers. They weigh nothing.
Loperamide stops the symptom. It is useful for a flight or a bus journey you cannot get off, and it should not be used where there is a high fever or blood in the stool, because stopping the gut emptying is the wrong move in a serious infection.
A standby antibiotic is for the more severe episode, started by you when specific criteria are met rather than taken at the first loose stool. Our price list prices it per tablet, and the pharmacist will set out plainly when to start it and when not to.
- Oral rehydration salts - the essential item, for everyone
- Loperamide - symptom control for a journey you cannot interrupt
- A standby antibiotic - for a severe episode, on clear criteria
- Hand sanitiser, for when there is nowhere to wash
When to stop self-treating
Standby treatment is for the ordinary case. There are situations where it is the wrong tool, and the point of this page is that you know them before you are ill in a hotel room at two in the morning.
Get medical help rather than reaching for your own supply if there is blood in the stool, a temperature above thirty-eight and a half, vomiting that will not let you keep fluids down, symptoms lasting beyond three or four days, or if the person affected is a young child, pregnant, or managing a long-term condition.
- Blood in the stool
- A fever above 38.5C
- Vomiting that prevents you keeping fluids down
- Symptoms lasting more than three or four days
- A young child, a pregnant traveller, or anyone with a significant medical condition
- Signs of dehydration: very little urine, dizziness on standing, confusion
Prevention, honestly rated
Food and water care genuinely reduces the risk, and no amount of it eliminates it - you will eat something someone else has prepared at some point. Bottled or boiled water, no ice unless you know the water, fruit you peel, food served hot rather than tepid, and hand washing before eating are worth doing because they move the odds.
The oral cholera vaccine gives some brief partial protection against one of the several causes. It is not a sensible reason on its own to take the course, and we will say so if that is what you came in for.