Travellers' diarrhoea

Travellers' diarrhoea is the commonest health affliction for visitors to developing countries and to resorts with an inadequate water supply and sewage disposal systems. Attack rates may exceed 50% and although rarely a severe health hazard may be the cause of an economic deprivation to a community if it discourages tourism. Enterotoxigenic Escherichia coli (ETEC) is the predominant causative organism. It is spread from man to man through water and food. The fundamental preventative strategy must be an improvement in drinking water supplies, safe sewage collection and disposal, and the achievement of high levels of hygiene at all stages of the food chain. Travellers visiting under-developed areas can take simple dietary and beverage precautions. Prophylactic antimicrobial agents will reduce the risk to an individual but may be detrimental to the community by encouraging the emergence of resistant bacterial strains. Vaccines are being developed against ETEC. The corner stone of treatment is fluid replacement. Symptomatic relief can be provided by antimotility drugs and the disease shortened by antibiotics. There is a need for a greater understanding of the faecal-oral pathways, for ongoing epidemiological studies and for cost benefit analysis studies of prophylactic and treatment schedules.