Moderate diarrhoea

• Attend to hydration.

• Patient can self-administer antibiotic—e.g. norfloxacin 400 mg bd for 3 days, or ciprofloxacin; use co-trimoxazole in children.

• Avoid Lomotil or Imodium.

Fig. 12.1 Algorithm for adult travellers with acute diarrhoea Severe diarrhoea (patient toxic and febrile)

• Attend to hydration—use an oral hydrate solution, e.g. Gastrolyte or WHO formulation.

• Avoid Lomotil and Imodium.

• Antibiotic: norfloxacin or ciprofloxacin.

Note: There is increasing resistance to doxycycline and co-trimoxazole, especially in South-East Asia. Persistent diarrhoea

Any travellers with persistent diarrhoea after visiting less developed countries, especially India and China, may have a protozoal infection such as amoebiasis or giardiasis. If the patient has a fever and mucus or blood in the stools, suspect amoebiasis. Giardiasis is characterised by abdominal cramps, flatulence, and bubbly, foulsmelling diarrhoea persisting beyond 2 to 4 days. Treatment

Giardiasis: tinidazole or metronidazole Amoebiasis: metronidazole or tinidazole

Patient can self-administer these drugs and carry them if visiting areas at risk, but they can have a severe adverse reaction with alcohol.

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