Travellers' diarrhoea in Sharm El-Sheikh: what actually helps

Every summer week I see visitors who have lost two or three days of a holiday to diarrhoea and vomiting. Most of them were told something that was wrong: that it was "the water", that they should stop eating, or that they needed antibiotics immediately. Here is what the evidence says.

What causes it

In resort settings the usual culprits are viruses (norovirus especially) and bacteria such as E. coli and Campylobacter, spread mostly through food handling and person-to-person contact — not tap water in a modern hotel, which is chlorinated. Buffets, ice-cream machines and shared surfaces matter more than the water you brush your teeth with.

What to do

• Fluids first. Oral rehydration solution from any pharmacy, small amounts often. Water, diluted juice and salty soup also count. Avoid large volumes of very sweet drinks.
• Keep eating. Bland food as soon as you can face it. Fasting doesn't shorten the illness.
• Loperamide is reasonable for adults with watery diarrhoea and no fever or blood — for a long bus trip, say. Not for children.
• Antibiotics help in moderate-to-severe bacterial cases, particularly with fever, and can shorten the illness by a day or more. They do nothing for viral cases. A doctor should decide.

When to see a doctor

Fever above 38.5 °C, blood in the stool, inability to keep fluids down, severe abdominal pain, symptoms beyond 72 hours, or any diarrhoea in a young child, an elderly person, a pregnant woman or someone with a chronic illness. These need assessment the same day.

Prevention

Hand hygiene before eating is worth more than any restriction on what you eat. Choose food that's hot and freshly cooked, be wary of items that have sat in a warm buffet, and peel fruit yourself. A pre-travel consultation can include a standby treatment plan so you don't have to find a doctor at 2 a.m.