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Travellers’ Diarrhoea in the Older Traveller

About the author


Beverley Tompkins

Specialist Travel Health Nurse AFTM RCPS (Glasg)

Beverley is Nomad's Specialist Travel Health nurse. She started nursing in infectious diseases before joining Nomad in 2010 to pursue her career as a Travel Health Nurse. Beverley is an Associate member of the Faculty of Travel Medicine at the Royal College of Physicians and Surgeons, Glasgow and member of the British Travel and Global Health Association. Beverley is very passionate about travel health, when she is not in clinic she enjoys writing articles on the subject and presenting.

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Using the Nomad clinic services gives you a one-to-one experience with a qualified, highly trained, travel health nurse.

The consultation includes:

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  • Advice on preventative measures you can take

Your pharmacy based travel clinic is all very well but for specialist advice at the same or lower cost come to Nomad. This is strongly advised if you are on a more adventurous or complex itinerary, or have special medical needs. Nomad Travel Clinics are specialists in:

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allowing 6-8 weeks for your vaccination programme, you have time to fit in full courses of vaccines where required which provides you with the best possible protection against certain vaccine preventable diseases. If you don’t have time to complete courses before you go, you risk travelling with little or even no protection against sometimes high risk diseases.

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Travellers’ diarrhoea (TD) is the most common illness for travellers visiting developing countries. The most common cause of TD are bacterial infections such a E.coli and Campylobacter. Due to a natural decline in immunity in older people, older travellers are more likely to experience TD than younger travellers and need to be prepared prior to travel to reduce and manage the risk of infection.

It is important not to rely on healthcare abroad to manage TD due to risks of counterfeit medication, infection risks and poor medical care in developing countries. For older adventure travellers it is important to be aware that supportive medical treatment may not be close by and that delay in treatment could significantly impact on health and safety.

TD can be a serious risk factor for older travellers who have pre existing medical conditions as it can cause considerable fluid loss causing dehydration particularly in very hot and humid climates. This has the potential to affect the absorption of important medicines increasing the risk of complications of well maintained conditions. Dehydration can also worsen and complicate pre existing medical conditions such as heart disease, diabetes and kidney impairment.

Ways to help reduce the risk of TD:
• Wash hands before handling food and after using the toilet
• Carry an antibacterial hand gel for emergencies
• Make sure plates, cups and other utentsils are properly clean before using
• Drink bottled, boiled or purified water
• Avoid shellfish if possible
• Eat hot freshly cooked food and peel able fruit


Pre and probiotics

There is currently ongoing research into the use of prebiotics and probiotics in the prevention of TD and taking this prior to and during travel may offer some protection in preventing TD by increasing friendly bacteria in the gut and supporting the guts natural defences. There are several products on the market for travel such as Bimuno Travel aid and Optibac - for travelling abroad.


Loperamide (known by many and Immodium) is an anti-motility drug that brings symptom relief by reducing the number of unformed stools. Some travellers believe that loperamide keeps the bacteria in the gut, prolonging the illness so are reluctant to use it. Loperamide increases absorption of fluids in the bowel and electrolytes to help maintain hydration and normalise intestinal transit times. If use correctly is an important medicine in the management of mild TD particularly in the older travel to reduce the risk of dehydration.

Antibiotics are used for the self treatment of moderate to severe symptoms of TD (3 or more loose motions within 24 hours with distressing symptoms abdominal cramping and or fever). Ciprofloxacin and Azithromycin are two common antibiotics recommended for the self treatment of TD. A travel health specialist will advise if these are suitable for you.

Antibiotics older travellers may be recommended include:
• Long term travellers to developing countries with poor access to healthcare
• Those taking Proton Pump inhibiters such as Lansoprazole, Omperazole
• Those with Inflammatory bowel diseases such as Crohns and Ulcertaive colitis
• Those who are immunocompromised (taking immunosuppressive/ steroid drugs)
• Diabetes

Book Now to visit one of the Nomad Travel Health Nurses who can undertake an individual risk assessment and give up to date advice on appropriate standby treatment for Travellers’ diarrhoea.