Traveler’s diarrhea: what to do in the first 24 hours
Traveler's diarrhea affects 30–70% of travelers to developing countries. It's usually not dangerous — but poor management can turn a mild episode into a medical emergency. This guide gives you a calm, step-by-step plan for the first 24 hours.
Immediate steps (Hour 0–4)
- Stop eating solid food — let your gut rest.
- Start oral rehydration salts (ORS) immediately — small, frequent sips every 5–10 minutes.
- Track frequency: count episodes and note any blood, mucus, or fever.
- Find the nearest pharmacy and hospital location — just in case.
Severity assessment
Classify your situation to decide your next step:
MILD
Watery stool <4×/day, no fever, no blood
ORS + rest. Monitor for 24 hours. Usually resolves in 1–3 days.
MODERATE
Watery stool 4–8×/day, mild cramps, low fever (<38.5°C)
Aggressive ORS (200 ml after each episode). Consider loperamide ONLY if no fever and no blood. Bismuth subsalicylate as alternative.
SEVERE
>8×/day, high fever (>38.5°C), blood in stool, severe cramps
SEEK MEDICAL HELP IMMEDIATELY. Do NOT take loperamide. You may need antibiotics and IV fluids.
ORS: your most important tool
If you don't have commercial ORS sachets, make your own:
1 liter of clean (boiled or bottled) water + 6 level teaspoons of sugar + ½ level teaspoon of salt
Drink at least 200 ml after each loose stool. For adults, aim for 2–3 liters per day minimum.
OTC medication options
Loperamide (Imodium)
Slows gut motility. ONLY for mild/moderate cases WITHOUT fever or blood. Max 8 mg/day. Do NOT use in children under 12.
Bismuth subsalicylate (Pepto-Bismol)
Reduces frequency by ~50%. Safe for mild cases. Avoid if allergic to aspirin. Turns tongue/stool black (normal).
Oral rehydration salts
Not a drug but the #1 treatment. Replaces lost electrolytes. Available at any pharmacy worldwide.
NEVER take loperamide if you have fever (>38°C), bloody stool, or severe abdominal pain. It can trap bacteria in the gut and worsen the infection.
Red flags — go to hospital
Seek emergency medical care if ANY of these occur:
- Blood or mucus in stool
- Fever above 39°C (102.2°F)
- No urination for 8+ hours (severe dehydration)
- Dizziness, confusion, or fainting when standing
- Severe abdominal pain (not just cramps)
- Symptoms worsening after 24 hours despite ORS
- Vomiting so severe you cannot keep fluids down
Special cases
Children under 5
Dehydrate much faster than adults. Start ORS immediately — 50–100 ml after each loose stool. NEVER give loperamide. Seek medical help if child refuses fluids, has sunken eyes, or seems unusually drowsy.
Pregnant women
ORS is safe and essential. Do NOT take bismuth subsalicylate (aspirin-related) or loperamide without doctor approval. Seek medical help earlier — dehydration is riskier during pregnancy.
Elderly / immunocompromised
Lower threshold for seeking help. Dehydration is more dangerous. Consider medical consultation even for moderate cases. If on immunosuppressants, contact your prescribing doctor.
Recovery (24–48 hours)
- Start with bland foods: rice, bananas, toast, plain crackers (BRAT diet).
- Continue ORS even as symptoms improve — you're still dehydrated.
- Avoid dairy, caffeine, alcohol, spicy food, and raw vegetables for 48–72 hours.
- Gradually reintroduce normal diet over 3–5 days.
- Probiotics (Saccharomyces boulardii) may shorten recovery — evidence is moderate.
Prevention for next time
- Drink only bottled or boiled water — check the seal is intact.
- Avoid ice in drinks (it's usually made from tap water).
- Peel fruit yourself — if you can't peel it, don't eat it.
- Eat food that is cooked and served hot.
- Wash hands with soap before eating — or use alcohol-based sanitizer.
- Avoid street food that has been sitting at room temperature.
Important medical note
This guide is for informational purposes and does not replace medical advice. Traveler's diarrhea is usually self-limiting, but complications (severe dehydration, dysentery, parasitic infection) require professional treatment. If symptoms persist beyond 48 hours or include red flags, seek medical help immediately.