So what do we do with our group?
Firstly we need to make sure no-one else gets infected if possible. That means no sharing water bottles or food, being super strict about washing hands before eating (particularly if eating communally) and after using the toilet.Consider bringing food to your patient rather than letting them use communal eating facilities and try not to use communal utensils. Ideally everyone should have a bottle of hand sanitiser to use regularly, although soap and water is more effective.
One of the safest treatments is oral rehydration solution (ORS/dioralyte/enerlyte). This is a mixture of salt and sugar that increases water absorption in the intestines, reducing the volume of diarrhoea and preventing dehydration.
Loperamide (Immodium) is effective at controlling diarrhoea although it should not be given to children, those with high fevers or bloody diarrhoea. Bismuth subsalicylate (Pepto-bismol/pepti-calm) is an effective medication for TD, reducing episodes of diarrhoea by around 50%. Be aware it blackens the tongue and stools, can reduce effectiveness of doxycycline for malaria prophylaxis and shouldn’t be used in under 16 year olds. ORS, bismuth and loperamide are available without prescription.
What about antibiotics?
Most medical guidance suggests trying antibiotics if the diarrhoea persists over 72 hours. For SE Asia/India a single dose of Azithromycin (1 gram) can be used, single dose ciprofloxacin(500mg-1g) for other regions (*For updated guidance as of August 2019 see note below). When in a remote area far from medical care or when persistent diarrhoea causes logistical difficulties (such as in our case) it may be acceptable to start antibiotics before 72 hours have elapsed. There is good evidence that using loperamide (immodium) with antibiotics shortens the duration of diarrhoea.
Anything I should look out for?
Diarrhoea can be an early sign of more serious illness such as malaria or appendicitis. Diarrhoea with blood in it or accompanied with a fever >38C means you should consider getting your patient to a medical facility.