Travelers’ Diarrhea Treatment in Phuket: Rehydration and the Right Antibiotic
Clinically reviewed by Dr. Ponlawat Pitsuwan, Physician, Takecare Clinic Phuket. Last reviewed: September 2026.
“Traveller’s diarrhoea tends to arrive in the first week of a holiday, often on day three or four, once people have relaxed about ice, salads and street stalls. Many of the visitors we see in Kata and Patong have already taken ciprofloxacin they brought from home and are puzzled that it has not worked. In this part of the world that is not surprising, and choosing the right antibiotic, or none at all, is most of what we do.” Dr. Ponlawat Pitsuwan
What is traveller’s diarrhoea?
Traveller’s diarrhoea is the most common illness in people visiting tropical countries. Doctors define it as three or more unformed stools in 24 hours, often with cramps, urgency, nausea or a mild fever, starting while you are travelling or within about ten days of arriving home. It is caught from food or water contaminated with small amounts of faecal bacteria, which your gut is not yet used to.
Most cases are bacterial. The commonest cause worldwide is enterotoxigenic Escherichia coli (ETEC), a strain of E. coli that makes a toxin which pulls water into the bowel. In Thailand and the rest of Southeast Asia, Campylobacter is also a major cause, and it matters because it is often resistant to fluoroquinolone antibiotics such as ciprofloxacin. Norovirus, Shigella, Salmonella and, less often, parasites such as Giardia make up the rest.
The difference from food poisoning is timing and pattern. Food poisoning usually hits hours after one identifiable meal, with vomiting to the fore; our page on food poisoning treatment covers that. Traveller’s diarrhoea tends to build over a day, is dominated by loose stools rather than vomiting, and usually has no single meal to blame.
How severe is it? Symptoms that change the plan
International travel medicine guidance sorts traveller’s diarrhoea by how much it affects you, not by the number of trips to the toilet. That grading decides the treatment.
| Severity | What it looks like | Usual treatment |
|---|---|---|
| Mild | Loose stools, tolerable, you can still go out | Oral rehydration; loperamide can be considered; no antibiotic |
| Moderate | Distressing, interferes with plans or a flight | Rehydration, loperamide, and an antibiotic may be offered |
| Severe | Incapacitating, or any bloody diarrhoea (dysentery) | Azithromycin, rehydration, IV fluids if needed; avoid loperamide |
| Fever above 38.5°C | Suggests invasive bacteria such as Campylobacter or Shigella | Doctor review the same day |
| Lasting more than 14 days | Persistent diarrhoea, possibly a parasite | Stool testing and targeted treatment |
Untreated, most traveller’s diarrhoea lasts three to five days. With a suitable antibiotic, moderate and severe cases often settle within a day. Diarrhoea that drags on beyond two weeks is a different problem with different causes, which we explain in our guide to diarrhoea treatment for persistent symptoms.
How we treat traveller’s diarrhoea at Takecare
At your visit the doctor asks when it started, how often you are going, whether there is blood or mucus, whether you have a fever or vomiting, what you have already taken, and when you are due to fly. We check your pulse, blood pressure and temperature and examine your abdomen for tenderness. Most people need nothing more to reach a decision. Stool testing in the laboratory is reserved for bloody or persistent diarrhoea, or when a first treatment has failed.
Rehydration first
Oral rehydration solution (ORS) is the foundation for every severity. It contains salt and glucose in a ratio that lets the gut absorb water even while it is inflamed. Sip it steadily, roughly a glass after each loose stool, and keep eating simple food as soon as you want to. If you are vomiting too much to drink, or you are dizzy, a litre of fluid through an intravenous drip corrects dehydration quickly. This is the evidence-based use of IV drip therapy in Phuket.
Loperamide, with cautions
Loperamide slows the gut and cuts the number of trips to the toilet. It is reasonable for adults with watery diarrhoea and no fever, for example to get through a flight or a boat transfer. It should not be used if you have blood in the stool or a fever, because slowing the bowel can keep invasive bacteria inside for longer. It is not recommended for young children. Stop it if your abdomen becomes swollen or painful, or if you have had no bowel movement for two days.
Antibiotics that work in Southeast Asia
When an antibiotic is justified, azithromycin is the preferred choice for travellers in Southeast Asia, given as a single dose or a short course of up to three days. It is chosen because Campylobacter here is frequently resistant to ciprofloxacin and other fluoroquinolones. Azithromycin is also the safer option for children and in pregnancy, at doses adjusted by the doctor. Rifaximin is an alternative for watery diarrhoea in some countries, but it is not suitable for bloody or feverish illness. We do not give antibiotics for mild diarrhoea: they add side effects and can disturb the gut bacteria that protect you, occasionally leading to Clostridioides difficile infection.
When to see a doctor
See a doctor the same day if you have blood or mucus in your stool, a temperature above 38.5°C, severe cramps, vomiting that stops you keeping fluids down, or diarrhoea that has gone on for more than three days without improving. Children, pregnant women, older adults and anyone with diabetes, kidney disease, inflammatory bowel disease or a weakened immune system should be seen sooner, because they dehydrate faster or are at higher risk of complications.
Go directly to a hospital emergency department, or call 1669 in Thailand, if someone is confused or very drowsy, has fainted, has passed no urine for 12 hours, or has severe abdominal pain with a rigid, swollen tummy.
After you return home
Tell your doctor at home that you have been in Thailand if diarrhoea continues beyond two weeks, if you develop a fever after returning, or if you notice weight loss. Persistent symptoms may be a parasite such as Giardia, a lingering bacterial infection, or post-infectious irritable bowel syndrome, a bowel sensitivity that can follow a bout of gastroenteritis and slowly settles over months. Ask about a stool test rather than another course of antibiotics.
Prevention and early detection
Drink bottled or properly filtered water, including for brushing teeth if you have a sensitive stomach. Ice in established Phuket restaurants and hotels is generally made from purified water; be more cautious with ice from unknown sources. Choose food that is cooked in front of you and served hot, peel your own fruit, and favour busy places with fast turnover. Wash your hands with soap before eating.
Bismuth subsalicylate taken during travel can reduce the risk modestly, but it turns the tongue and stools black and is not suitable for children, in pregnancy or with aspirin allergy or blood thinners. Probiotics have weak and inconsistent evidence. Preventive antibiotics are not recommended for most travellers. The most useful early step is to start ORS at the first loose stool.
Visiting Takecare Clinic in Phuket
You do not need an appointment. Takecare Clinic Bangtao (Cherngtalay), Takecare Clinic Kata-Karon and Takecare Clinic Patong are all open 24 hours, seven days a week. Seeing a walk-in doctor in Phuket usually takes under 30 minutes, and the on-site pharmacy supplies ORS and any antibiotic before you leave.
If you cannot risk a taxi ride, a doctor hotel visit in Phuket brings the assessment, medicine and, if needed, an IV drip to your room.
Message us on WhatsApp or call 081-718-9080. We confirm the price on WhatsApp before your visit, offer direct billing with most travel insurers, and supply a medical report and itemised receipt for your claim.
Related services and treatments
If upper-stomach burning and nausea remain after the diarrhoea settles, particularly after alcohol or anti-inflammatory painkillers, our gastritis treatment page explains the next step. For vomiting that began within hours of a particular seafood dinner or buffet, see how we treat food poisoning in Phuket.
Summary
Traveller’s diarrhoea is common, usually bacterial, and usually short. Oral rehydration is the treatment for everyone. Loperamide helps adults with watery diarrhoea but should be avoided with fever or blood. When an antibiotic is needed in Southeast Asia, azithromycin is preferred because Campylobacter here is often resistant to ciprofloxacin. Bloody stools, high fever, dehydration and symptoms beyond three days need a doctor, and anything still going after two weeks, including after you fly home, deserves a stool test.
“Start rehydration salts at the first loose stool, keep loperamide for watery diarrhoea without fever, and if you are bleeding, feverish or flying tomorrow, come in. Getting the antibiotic right for this region is the difference between one bad day and five.” Dr. Ponlawat Pitsuwan
Frequently asked questions
How long does traveller’s diarrhoea last?
Without treatment most cases last three to five days, and about one in ten goes on for more than a week. A suitable antibiotic shortens moderate or severe illness to around a day for many people. If your symptoms last more than 14 days, the cause is often different, such as a parasite, and a stool test is the next step rather than more antibiotics.
Which antibiotic works best for traveller’s diarrhoea in Thailand?
Azithromycin is usually preferred in Thailand and Southeast Asia, because Campylobacter, a common cause here, is frequently resistant to ciprofloxacin and similar fluoroquinolones. It is given as a single dose or a course of up to three days. Mild diarrhoea does not need an antibiotic at all, so a doctor should decide whether you need one.
Is it safe to take loperamide on holiday?
For adults with watery diarrhoea and no fever, loperamide is safe and useful, for example before a flight or long drive. Do not take it if you have blood in your stool or a temperature, because it can keep invasive bacteria in the gut longer. It is not recommended for young children. Keep drinking oral rehydration solution while you take it.
Do I need an appointment to be seen?
No. Walk in to any of our branches in Bangtao, Kata or Patong at any hour, and an English-speaking doctor will usually see you within minutes. Most visits, including medicine from our pharmacy, take under half an hour. If you prefer, send us a WhatsApp message first with your symptoms and flight date.
Can a doctor treat me at my hotel?
Yes. If you are too unwell or too close to a bathroom to travel, a doctor can visit your hotel or villa anywhere in Phuket, 24 hours a day. The doctor assesses how dehydrated you are, starts treatment, and can put up an IV drip in your room if you cannot keep fluids down.
Will my travel insurance pay for treatment?
Most travel insurance policies cover a doctor visit, medicine and IV fluids for diarrhoea that starts during your trip. We offer direct billing with most travel insurers, and if yours reimburses you instead, we provide a medical report and itemised receipt. Message us your insurer’s name on WhatsApp and we will confirm before you arrive.
Sources
CDC Yellow Book: Travelers’ diarrhea. NaTHNaC TravelHealthPro: Travellers’ diarrhoea. NHS: Diarrhoea and vomiting.
Traveller’s diarrhoea, travelers’ diarrhea, Delhi belly, gastroenteritis, dysentery, enterotoxigenic Escherichia coli, ETEC, Campylobacter, Shigella, Salmonella, norovirus, Giardia, Clostridioides difficile, fluoroquinolone resistance, azithromycin, ciprofloxacin, rifaximin, loperamide, bismuth subsalicylate, oral rehydration solution, ORS, IV fluids, post-infectious irritable bowel syndrome, CDC Yellow Book, NaTHNaC, NHS, Bangtao, Cherngtalay, Kata, Karon, Patong, Phuket, Dr. Ponlawat Pitsuwan, Takecare Clinic Phuket.
This page is general health information and not a substitute for a medical consultation.