This is a general guide and does not replace the advice of a medical practitioner or pharmacist.
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:
- 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 rehydrate.org “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.
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 rehydrate.org’s articles):
- N.B. rehydrate.org 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:
- sports/soft drinks and soup have rehydrating properties (but probably won’t provide potassium)
- make your own rehydration solution
- If your illness is prolonged bananas are a good source of potassium.
- Maintain hygiene.
last updated 19 June 2010 | Author Andy W+