Traveller's diarrhoea self-treatment — DTM&H MCQ

Correct answer: B — Oral rehydration with standby azithromycin for severe illness

The correct answer is B, oral rehydration with standby azithromycin for severe illness. For a traveller heading to a remote, high-risk destination like rural Peru with limited access to medical care, UK travel health guidance recommends carrying a standby antibiotic alongside oral rehydration salts for self-treatment of severe watery diarrhoea. NaTHNaC states that azithromycin (500 mg once daily for 1 to 3 days) is first-line treatment for traveller's diarrhoea and can be considered as a standby option for patients at high risk of severe illness or for those visiting high-risk remote areas. Rehydration remains the cornerstone of management because dehydration, not the infection itself, is the main immediate threat, and this is especially pertinent in a 62-year-old with vascular disease who is more vulnerable to hypovolaemia and its cardiovascular consequences. Fluoroquinolones like ciprofloxacin are now second-line due to resistance and MHRA safety warnings, making azithromycin the preferred standby choice. Why the other options are wrong: A, Routine daily ciprofloxacin prophylaxis for the whole trip: routine antibiotic prophylaxis is not recommended because of adverse effects, resistance selection, and MHRA restrictions on fluoroquinolone use to situations where other antibiotics are unsuitable. B, Loperamide alone for dysentery with fever: loperamide should not be used when there is blood, mucus, or high fever, as it can worsen invasive infection by delaying clearance of the pathogen; this scenario also explicitly has no blood or fever. C, Avoid fluids until stool frequency falls: withholding fluids worsens dehydration and is directly contrary to rehydration being the priority in diarrhoeal illness. E, Tinidazole as malaria prophylaxis: tinidazole is an antiprotozoal, not an antimalarial, and has no role in malaria chemoprophylaxis. Key point: In remote, high-risk destinations, standby azithromycin plus oral rehydration salts is the recommended self-treatment for severe watery traveller's diarrhoea without blood or fever.

Reference: NaTHNaC (National Travel Health Network and Centre), TravelHealthPro, Traveller's Diarrhoea factsheet, https://travelhealthpro.org.uk/factsheet/53/travellers-diarrhoea