This is a general guide and does not replace the advice of a medical practitioner or pharmacist.

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If you are trekking in Nepal I’m sure you will be conscious of health risks. But don’t think a trip to a more popular destination with a top end tour company means you can eat and drink without worry. On my up-market Nile cruise (clean luxury ship, well presented meals etc) two people in my group of five had to retire to their cabins for 3 days.

On long trips don’t go without:

courtesy of

  • Low-osmolarity rehydration sachets with potassium (diarrhoea is due to the stomachs inability to absorb water, these sachets add sugars & lost “salts” to water enabling it be absorbed). Ensure you don’t just end up with expensive packets of sugar, buy from a reputable source like Walgreens or Walmart in the US, or Superdrug in the UK.
  • Imodium or other Loperamide based product: To quote “Use cautiously as they are said to prolong the illness and may increase the risk of a carrier state. They are useful in some cases, however, when it is important that you don’t have diarrhea (e.g. when travelling on a bus).” You should seek a doctor’s advice, it’s a temporary travel measure, not a cure. There are circumstances when Imodium shouldn’t be used (e.g. if you have blood in your stools) so read the instructions carefully.
  • Toilet Roll (I’ve stayed in hotels with vanishing toilet paper)

Preventions – medicines and vaccines

In this article I wrote about my own positive experience of Dukoral back in 2010. Before writing this 2017 update I read the US CDC’s: “traveler’s diarrhea“, and the UK NHS’s “traveller’s diarrhoea” pages. The NHS page has a section on preventative medication.

Most medicines/vaccines can have side effects and are not suitable for everyone – take the advice of your medical practitioner/issuing pharmacy and the product’s notes.

Pepto-bismol tablets

how effective?The NHS says “An effective approach to prevent travellers’ diarrhoea with an overall efficacy of about 60%.”

effective for: 3 weeks (based on maximum usage advised by NHS)

when to take: during your stay 4 x a day for a maximum of 3 weeks

availability: can be bought over the counter in many countries including US & UK.

who should not take? check with the pharmacist, but the list includes under 16s and those on Asprin or Warfarin medication


Dukoral Cholera and Travelers Diarrhea vaccine drink

availability: over the counter without prescription to adults in Canada (except Quebec). Currently (2017) NOT licensed in the US. In the UK it is only licensed for use as a Cholera vaccine and requires a prescription.

how effective?It provides protection against one form of E.coli (however, this is the most common cause of Travelers Tummy).

effective for: about 3 months for Travellers Tummy much longer for Cholera

when to take: taken twice as a drink, one to 6 weeks apart and completed at least one week BEFORE travel. (suppliers instructions)

who should not take & side effects? check with your doctor/the pharmacist


Practical Prevention (boil it, peel it, cook it or forget it)

You will have to balance practicality and enjoyment against risk.

  • Check your travel guide for advice on safety of drinking mains water. If in doubt:
    • clean your teeth with bottled water.
    • boil water, or use iodine tablets and a water filter.
  • Drink bottled water; don’t buy from a mobile vendor, make sure the seal is intact when you purchase.
  • Never have drinks with ice. Don’t use chillers that dispense drinks such as coke they may have been diluted with untreated water.
  • Take water with you. Drink often and plenty in a hot climate.
  • Milk may not have been pasteurised or sterilised.
  • Don’t eat food that appears to be kept warm all day.
  • Send your meal back if it is not hot throughout or cooked thoroughly.
  • Peel fruit before eating, and beware salads (you can’t trust the water they were washed in)


  • wash your hands before handling food/use a hand sanitizer
  • clean preparation and storage of food
  • storage to protect from insects


See a doctor.

Rehydrate yourself (most of the comments below are based on’s articles):

  • N.B. states a solution containing more than 3% sugar can have a negative effect.
  • use your low-osmolarity oral rehydration sachet’s (ORS) with clean water and follow the instructions to ensure appropriate ratio of water to contents.
  • If you don’t have any sachets:
  • If your illness is prolonged bananas are a good source of potassium.
  • Maintain hygiene.

last updated 19 June 2010 | Author Andy W+