Background: This is a review of some of the non-pharmacotherapeutic interventions in travellers diarrhoea (TD) looking particularly at the role of pre and probiotics, the evidence behind water purification and the impact of advice given and its adherence by travellers.
Method: A systematic review of the research completed under section using the listed key words and searched using the databases of Google Scholar, Journal of Travel Medicine, QxMD, ReadCube and The Knowledge Network.
Results and conclusions: Travellers' diarrhoea and use of pre/probiotics: There is no significant evidence to suggest the benefit of using pre or probiotics to prevent or treat TD. A new second generation of B-GOS prebiotics shows some potential in preventing the incidence and symptoms of TD but lack high levels of graded evidence. Recent reports from the biotics industry suggest that a review of the above issues is being addressed and in the future more robust studies may be completed. The evidence behind water purification and diarrhoeal disease: Evidence suggests there is no direct correlation that water purification has an impact on diarrhoeal disease, although some studies underline the value of water purification. The use of bottled water is questioned as being unreliable due to the inconsistencies of microbiological safety. With new water purification products and methods being introduced a benefit could be found for publishing effectiveness against pathogen groups to improve comparison. Are travellers given good sanitary advice and do they follow it? The advice given to travellers by non-clinical sources is unregulated and not a statutory obligation of a reservation to travel. Within the clinical sector the advice provided and the outcomes of advice provision do not correlate with a reduction in TD as a variance can occur by travellers' changes and behaviours towards the advice given. Following recommended advice and consuming higher risks foods do not correspond directly with levels of reported TD, suggesting attitudes and practices deviate away from this advice when travelling.