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

Correct answer: B — Food and water precautions with oral rehydration plan and selective standby antibiotics

Option B, food and water precautions with an oral rehydration plan and selective standby antibiotics, is correct because routine antibiotic prophylaxis is not recommended for healthy travellers and current UK guidance reserves standby antibiotics for high risk individuals or severe dysenteric illness. This 28 year old is healthy with no immunosuppression, so the mainstay is behavioural prevention (safe food and water choices), self treatment of dehydration with oral rehydration salts, and carrying a standby antibiotic (typically azithromycin) to use only if diarrhoea becomes severe or systemic. This approach preserves flexibility for a 3 week itinerary, avoids unnecessary drug exposure, and matches the low threshold for adverse effects versus benefit seen in prophylactic regimens. Guidance explicitly states prophylaxis is rarely, if ever, indicated in low risk travellers. Why the other options are wrong: C. Routine albendazole throughout travel: albendazole is an anthelmintic with no role in preventing bacterial or viral traveller's diarrhoea, and routine deworming prophylaxis is not part of standard pre-travel advice. E. Avoid vaccination and rely on loperamide alone: loperamide only controls symptoms and does not prevent infection; vaccination (for example against typhoid or cholera where indicated) reduces risk and should not be withheld, and loperamide is contraindicated in dysentery with fever or blood in stool. D. Daily fluoroquinolone prophylaxis for the whole trip: continuous antibiotic prophylaxis is not advised for healthy low risk travellers because of resistance selection, photosensitivity, tendon and adverse effect risk, and it removes flexibility needed for a multi week itinerary. A. Cholera treatment salts instead of hygiene advice: rehydration salts treat established diarrhoeal losses but do not substitute for hygiene and food and water precautions, which are the primary preventive measure. Key point: For healthy travellers, prevention rests on hygiene and safe food and water practices plus oral rehydration, with standby (not daily prophylactic) antibiotics reserved for severe or high risk scenarios.

Reference: NHS Nottinghamshire APC / Antimicrobial Prescribing Guidelines for Primary Care, Traveller's Diarrhoea, updated December 2025, https://www.nottsapc.nhs.uk/media/h4uc35so/travellers-diarrhoea.pdf