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Traveller’s diarrhoea — MRCGP AKT MCQ

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EasyInfectious DiseasesTraveller’s diarrhoeaMRCGP AKTUKMLAPARA

A 29-year-old immunocompetent man develops frequent watery diarrhoea and mild abdominal cramps during the first day after returning from a holiday in Thailand. He has no blood or mucus in the stool, fever, vomiting or severe abdominal pain. He is drinking normally, passing urine and has no clinical features of dehydration. What is the most appropriate initial management?

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Correct answer: B — Advise oral rehydration and short-term loperamide if required

This is uncomplicated traveller's diarrhoea in a systemically well adult who can maintain oral intake. The initial priority is fluid and electrolyte replacement; oral rehydration solution can be used, and short-term loperamide may provide symptomatic relief because there is no fever, bloody stool or severe abdominal pain. Routine empirical antibiotics are unnecessary for mild, self-limiting illness. Ciprofloxacin should not be started automatically, while metronidazole is reserved for specific susceptible infections such as giardiasis, typically considered with persistent symptoms. Co-amoxiclav is not a standard treatment for traveller's diarrhoea. Intravenous fluids and admission are reserved for significant dehydration, inability to maintain oral intake, severe systemic illness or other complications.

Reference: Nottinghamshire Area Prescribing Committee. Travellers' diarrhoea V3, treatment for symptom management. Updated December 2025. https://www.nottsapc.nhs.uk/media/h4uc35so/travellers-diarrhoea.pdf