Diarrhoea Treatment

Many adults with short-lived, uncomplicated diarrhoea can be assessed online. The clinician will review duration, stool frequency, recent travel, fever, blood or mucus in the stool, vomiting, abdominal pain, hydration, medicines, pregnancy status and relevant medical conditions.

Severe dehydration, blood in the stool, high fever, severe abdominal pain, persistent vomiting, confusion or significant immune suppression requires further assessment.

Yes. A pre-travel consultation can review destination, remoteness, underlying health conditions and whether standby treatment is justified. Antibiotics are not routinely supplied to every traveller.

No. Most traveller's diarrhoea is self-limiting. NaTHNaC advises that standby antibiotics should be considered carefully and are mainly reserved for travellers at higher risk of severe illness or those visiting high-risk remote areas where medical care may be difficult to access.

Acute diarrhoea means passing loose or watery stools more frequently than usual for a short period. It is commonly caused by infection, contaminated food or water, medicines or a temporary change in gut function.

Traveller's diarrhoea is diarrhoea that develops during or shortly after travel, usually after exposure to contaminated food or water. It is most commonly infectious.

Signs can include thirst, dry mouth, passing less urine, dark urine, dizziness, weakness and feeling light-headed on standing. Severe dehydration can cause marked drowsiness, confusion or collapse and needs urgent treatment.

Loperamide is an antimotility medicine used for short-term symptomatic treatment of acute diarrhoea. It slows intestinal movement, allowing more water to be absorbed and reducing stool frequency.

Current UK product information commonly recommends 4 mg initially, followed by 2 mg after each loose stool.

The maximum depends on the exact product. Many current over-the-counter 2 mg products are limited to 12 mg in 24 hours, while some prescription formulations allow up to 16 mg daily. Follow the exact product label or dispensing directions.

Loperamide is intended for short-term symptom relief. If acute diarrhoea has not improved within 48 hours, stop self-treatment and seek medical advice unless a clinician has given a different plan.

Do not use Loperamide where slowing the bowel could be harmful, including suspected bowel obstruction, severe colitis, marked abdominal swelling, or diarrhoea with blood and high fever unless specifically advised by a clinician.

Possible effects include constipation, abdominal cramps, nausea, wind, dizziness and headache. Stop treatment and seek medical advice for marked abdominal swelling, severe constipation or worsening abdominal pain.

Azithromycin is an antibiotic that can be used as standby treatment for traveller's diarrhoea in selected higher-risk travellers after an individual travel-health assessment.

NaTHNaC lists Azithromycin 500 mg once daily for 1 to 3 days as a first-line adult treatment option when an antibiotic is clinically indicated.

No. NaTHNaC gives a 1 to 3 day adult regimen. The standby plan supplied during the consultation should explain when to start treatment and how long to continue it.

Common effects include nausea, abdominal discomfort, diarrhoea and vomiting. Seek urgent help for a severe allergic reaction, fainting, severe palpitations or a serious skin reaction.

Azithromycin can interact with some medicines and may be unsuitable in people with certain heart-rhythm problems or significant liver disease. Your medication list and medical history should be reviewed before supply.

Replacing fluids and salts is the priority. Oral rehydration solution is especially useful when fluid losses are significant, vomiting is present or there is increased risk of dehydration.

Take frequent fluids, using small regular sips if you feel nauseated. Oral rehydration solution can replace both water and electrolytes when losses are substantial.

No. Eat when you feel able. Simple foods may be easier to tolerate, but prolonged fasting is not usually necessary. Maintain fluid intake even if appetite is reduced.

Use careful food and water hygiene. Choose food that is freshly prepared, thoroughly cooked and served hot, use safe drinking water and maintain good hand hygiene.

Most acute diarrhoea is self-limiting and often viral. Unnecessary antibiotics can cause side effects, disrupt normal gut flora and contribute to antimicrobial resistance.

Yes. NaTHNaC warns that travellers taking antibiotics can acquire resistant organisms and can also be at risk of antibiotic-associated infections such as Clostridioides difficile.

They may sometimes be used together in selected traveller's diarrhoea plans, but Loperamide should be avoided when there is blood in the stool, high fever or concern about invasive infection. Follow the individual standby instructions supplied.

Persistent symptoms should be reassessed, particularly if Loperamide has been used correctly without improvement. Depending on the history, stool testing or another diagnosis may need to be considered.

NaTHNaC advises seeking medical care if symptoms have not improved within 3 days. Earlier assessment is needed if warning signs develop.

Yes. Persistent post-travel diarrhoea may be caused by bacterial or parasitic infection and can require stool testing. Repeated self-treatment without assessment is not appropriate.

Seek urgent assessment for severe dehydration, confusion, collapse, blood in the stool, severe or worsening abdominal pain, persistent vomiting, high fever, jaundice, a widespread rash or severe systemic illness.

Blood or significant mucus can suggest invasive intestinal infection or another bowel condition. Do not rely on Loperamide alone and seek medical assessment.

NaTHNaC advises seeking medical care promptly for traveller's diarrhoea with a temperature of 38°C or higher, particularly when associated with blood or mucus in the stool or other concerning symptoms.

Severe, localised or worsening abdominal pain is not typical of uncomplicated diarrhoea and requires assessment to exclude another condition or invasive infection.

Pregnancy should be disclosed before treatment. The clinician will assess whether symptom treatment or standby antibiotic treatment is appropriate and select the safest option for the individual situation.

Standby treatment can be considered after a travel-health risk assessment where the destination, access to healthcare and individual risk justify it. It is not routinely supplied to every traveller.

If treatment is approved, you will receive clear instructions covering dose, maximum duration, hydration, when Loperamide should be avoided, when standby Azithromycin should be started and when to seek medical care.