Travelers' Diarrhea Prescription: When an Online GP Assessment May Help

Most traveler's diarrhea (traveller's diarrhoea) needs no prescription. Dr. Pedro Yelamo Vera, a GP licensed in Spain, sees patients by video in English and Spanish, and you see the same doctor every time. It is usually mild and settles within a week with fluids and rest. A prescription only matters for some trips. If you live in Spain and are going to South or Southeast Asia, Africa, Latin America or the Middle East, a doctor can decide whether a standby antibiotic suits you.

What is traveler's diarrhea?

Traveler's diarrhea is loose, watery stools that start during a trip or soon after. It usually comes from germs in food or water. Bacteria cause most cases in higher-risk regions, according to the CDC Yellow Book.

There are two different situations, and they need different advice:

• You are visiting Spain and get diarrhea. Spain is a low-risk destination. The cause is most often a stomach virus (viral gastroenteritis) or food poisoning. Rest and fluids are usually all you need.
• You live in Spain and are going somewhere higher-risk. Trips to South and Southeast Asia, Africa, Latin America or the Middle East carry a higher risk. This is where people ask about a standby antibiotic before they leave.

Typical symptoms, as Mayo Clinic lists them, are loose stools, cramps, an urgent need to go, and feeling sick.

How long does traveler's diarrhea last?

Diarrhea usually stops within 5 to 7 days. Vomiting usually stops within 1 or 2 days. Those are the figures the NHS gives for diarrhea and vomiting in adults.

You can pass the infection on while you have symptoms. The NHS advises staying off work or school until 48 hours after the last episode. Wash your hands well after the toilet and before you touch food. Diarrhea that lasts more than 14 days is called persistent. It needs a doctor and usually stool tests, because some causes, such as parasites, need a specific treatment.

What should you do first if you get diarrhea in Spain?

Start drinking oral rehydration solution from the first loose stool. Plain water does not replace the salt you lose. Most cases then settle on their own.

• Rehydrate. Ask the pharmacy for suero oral or sales de rehidratación oral. Mix sachets exactly as the pack says. Take small sips often, more after each loose stool.
• Eat light food when you feel ready. Small, plain meals are easier than fatty or spicy food. Avoid alcohol, fruit juice and fizzy drinks until you are better. If milk seems to make things worse, leave dairy for a few days.
• Loperamide can help with mild, watery diarrhea. In Spain it is sold without a prescription as Fortasec or Imodium, for adults and children over 12. Follow the leaflet. Do not take it with blood in the stool or a fever. Our guide to Imodium and loperamide in Spain explains when it is not suitable.
• Bismuth is not an option here. International guidance mentions bismuth subsalicylate, but Spain's official medicines database (CIMA, from the AEMPS) lists no authorised medicine with it. Ask the pharmacist what suits you instead.

Do you need antibiotics for traveler's diarrhea?

Usually not. The 2017 guideline of the International Society of Travel Medicine (ISTM, Riddle and colleagues) sorts cases by how much they affect you:

• Mild: annoying, but you can carry on with your plans. No antibiotic. Loperamide or bismuth may be used.
• Moderate: it gets in the way of your plans. An antibiotic may be used. Loperamide may be used alone or with an antibiotic.
• Severe: you cannot do anything, or there is blood in the stool. An antibiotic should be used. Azithromycin is the preferred choice for severe cases, bloody diarrhea or diarrhea with a fever. Single-dose courses can be used.

Antibiotics have real downsides. The CDC lists side effects, a bowel infection called C. difficile, and picking up resistant bacteria. Travelers who take antibiotics are more likely to bring resistant gut bacteria home. So a doctor weighs the benefit for you each time. In Spain, antibiotics always need a prescription.

Can you get a standby prescription before a trip?

Sometimes. A standby prescription is a medicine you carry and only take if you get moderate or severe diarrhea far from care. It suits some travelers, not all, and it is decided after a real assessment.

Taking an antibiotic to stop diarrhea before it starts (prophylaxis) is not advised for most travelers, says the ISTM guideline. A standby plan is different: you only take it if you fall ill.

The doctor will ask where you are going, for how long, and how far you will be from a clinic. He also asks about your health, pregnancy, your regular medicines and any allergies.

If a standby antibiotic is right for you, you also get a clear plan. It covers when to start it, when to keep drinking and wait, and which signs mean you must find a doctor where you are. Collect the medicine from a pharmacy in Spain before you leave. A private electronic prescription issued in Spain is dispensed in Spanish pharmacies. For vaccines and wider trip planning, see our travel medicine service.

Controlled medicines are never prescribed by video. Our guide to which medicines need a prescription in Spain explains what you can buy over the counter.

How can you prevent traveler's diarrhea?

Good habits with food, water and hands lower the risk. They matter most in higher-risk regions.

• Food. Eat food that is freshly cooked and served hot. Fruit you peel yourself is safer. Be careful with raw shellfish, salads and food that has sat out in the heat. The CDC sums it up as: boil it, cook it, peel it, or leave it.
• Water. In higher-risk regions, drink sealed bottled water, or water that has been boiled or treated. Avoid ice you are not sure about. Tap water in Spain is safe to drink in general.
• Hands. Wash with soap and water before eating and after the toilet. Hand gel helps when there is no sink, but it works less well than soap.
• A small kit. Pack oral rehydration sachets and your regular medicines in their original boxes.

Who should see a doctor sooner?

Some people get dehydrated faster or have more risk of problems. They should get advice on day one instead of waiting.

• Babies and young children. They get dehydrated faster than adults. Watch for a dry mouth, no tears, fewer wet nappies, or a child who is very quiet or floppy. Any of these, or a baby under six months with diarrhea, needs in-person care today.
• Pregnancy. Dehydration matters more, and some medicines are not suitable.
• Older people, and people with a weak immune system, diabetes, kidney disease or bowel disease.
• People on regular medicines that may not work well during diarrhea, or that depend on fluid balance, such as water tablets.

When is diarrhea an emergency?

Get urgent care if you have any of these. Call 112 if you are very unwell.

• Blood in the stool.
• A high fever.
• Severe belly pain.
• Signs of dehydration: little or dark urine, dizziness when you stand up.
• You cannot keep any fluids down.
• Confusion, fainting or a very fast heartbeat.
• A baby, a pregnant woman, an older person or someone with weak immunity who is getting worse.

A video visit is not the right tool for these. See our guides to emergency numbers in Spain and when to go to the ER instead of an online doctor.

What can a video visit help with, and what can it not?

A video visit works well for mild or moderate diarrhea without red flags. It also works for a medicines review and for planning a trip. It cannot treat severe dehydration or replace emergency care.

• Good for video: diarrhea that is not settling, questions about your medicines, trip planning.
• Not for video: no fluids staying down, bloody diarrhea with fever, severe pain, fainting or confusion.

The doctor will say plainly when video is not enough. No doctor can promise an antibiotic before seeing you.

Getting a medical assessment

You can book a video visit with Dr. Pedro Yelamo Vera, a GP licensed in Spain (Colegiado No. 484814280). The Urgent Care video visit costs €50 and lasts 15 minutes. Visits run every day from 07:30 to 20:30 (Spain time). It includes a medical report and an itemised invoice. Children and pregnant patients can be seen. You can also read about traveler's diarrhea care. A prescription is never guaranteed: it is issued only where clinically appropriate after a genuine evaluation, as a private electronic prescription under Spanish law. This service is for urgent, non-emergency care. In an emergency, call 112.

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