Traveller’s diarrhoea, food poisoning (Dukoral)

[steve54 464]

OK, on my past 2 trips to Bangkok/Pattaya I got sick and lost 2 days each time followed by an additional day or so of still not being 100%. I hate being sick and losing a significant portion of my available holiday.

On my last trip "ianoxon" from the Pattaya forum suggested that a Cholera vaccine offers some protection from food poisoning, so this post follows on from that suggestion and I have done is a bit of AI research and considered the benefits for me for future trips.

So here are some details that I have found out (cut and pasted from a long-winded AI series of questions and clarifications):

The Cholera vaccine protects against Cholera and enterotoxigenic E. coli (ETEC)   that produce heat-labile toxin — these can cause a type of traveller’s diarrhoea.

There is no/ZERO protection from other forms of food poisoning such as  

• • Campylobacter
  • Non-ETEC E. coli
  • Salmonella
  • Shigella
  • Norovirus
  • Staph toxins
  • Parasites (Giardia, etc.)

 

Having said that in “my view” the use of untreated water to clean utensils and prepare food combined with our hobby puts us more exposed to this type of food poisoning/infection than perhaps a sexually inactive tourist of say Europe (with treated water and higher food hygiene standards).

Apparently ETEC is one of the most common causes of traveller’s diarrhoea in Southeast Asia and we are maybe at an increased risk. So the vaccine itself can offer partial, short-term protection against ETEC-caused diarrhoea. This short term appears to be about 3 months.

For ETEC traveller’s diarrhoea (the partial protection):

• Peak protection: in the first 1–3 months after completing the course
• Meaningful protection fades after ~3 months

Virtually gone by 6 months (but still effective for Cholera for a total of 2 years)

The vaccine is taken orally in 2 doses

Ideal schedule:

• Dose 1: about 3–4 weeks before travel
• Dose 2: about 1–2 weeks before travel
• You are protected starting 1 week after dose 2

Booster

• One dose, at least 1 week before travel (Only valid if your last course was within 2 years)

So, this to me seems a valid and useful option for annual travellers and not so useful for residents (who perhaps have hardened up and have a bit more tolerance to local water/food than us blow-ins).

Anyway, my next trip is planned for early next year and I will be dosed up with Dukarol (the Cholera Vaccine) and hopefully avoid getting sick.

[taaseesanuk 4,702]

12 minutes ago, steve54 said:

OK, on my past 2 trips to Bangkok/Pattaya I got sick and lost 2 days each time followed by an additional day or so of still not being 100%. I hate being sick and losing a significant portion of my available holiday.

On my last trip "ianoxon" from the Pattaya forum suggested that a Cholera vaccine offers some protection from food poisoning, so this post follows on from that suggestion and I have done is a bit of AI research and considered the benefits for me for future trips.

So here are some details that I have found out (cut and pasted from a long-winded AI series of questions and clarifications):

The Cholera vaccine protects against Cholera and enterotoxigenic E. coli (ETEC)   that produce heat-labile toxin — these can cause a type of traveller’s diarrhoea.

There is no/ZERO protection from other forms of food poisoning such as  

• • Campylobacter
  • Non-ETEC E. coli
  • Salmonella
  • Shigella
  • Norovirus
  • Staph toxins
  • Parasites (Giardia, etc.)

 

Having said that in “my view” the use of untreated water to clean utensils and prepare food combined with our hobby puts us more exposed to this type of food poisoning/infection than perhaps a sexually inactive tourist of say Europe (with treated water and higher food hygiene standards).

Apparently ETEC is one of the most common causes of traveller’s diarrhoea in Southeast Asia and we are maybe at an increased risk. So the vaccine itself can offer partial, short-term protection against ETEC-caused diarrhoea. This short term appears to be about 3 months.

For ETEC traveller’s diarrhoea (the partial protection):

• Peak protection: in the first 1–3 months after completing the course
• Meaningful protection fades after ~3 months

Virtually gone by 6 months (but still effective for Cholera for a total of 2 years)

The vaccine is taken orally in 2 doses

Ideal schedule:

• Dose 1: about 3–4 weeks before travel
• Dose 2: about 1–2 weeks before travel
• You are protected starting 1 week after dose 2

Booster

• One dose, at least 1 week before travel (Only valid if your last course was within 2 years)

So, this to me seems a valid and useful option for annual travellers and not so useful for residents (who perhaps have hardened up and have a bit more tolerance to local water/food than us blow-ins).

Anyway, my next trip is planned for early next year and I will be dosed up with Dukarol (the Cholera Vaccine) and hopefully avoid getting sick.

Personally, if i get the shits I find it's best to do nothing to start. If it still persists after 48hrs I will take an Imodium, this always sorts it out.

In general, the main reason for dodgy guts is the cooking oil which is over used and richer than we are used to, the climate as well has an impact plus

the rigors of travel and eating at times we wouldn't normally due to the change in time zones, throw in the spices and other ingredients we also don't generally consume.

Yes, food poisoning can often be a reason, Thai's generally wash up with cold water as well, but if you are sensible and only eat what you can see being cooked fresh then

most of it can be avoided. Cheap street food that is set aside to sell having been cooked is a real red flag.

Finally, don't use tap water to clean your teeth, I know many people that say they do this but don't swallow it, I think you will always have some work it's way down and this

is a steadfast way to get a dodgy stomach.

[Genghis 2,984]

This might be an unpopular suggestion but one of my rules for staying healthy while travelling is to avoid hotel buffet breakfasts.

Fresh cooked eggs are the one exception I occasionally make but otherwise I just steer clear. I've been sick more from hotel breakfasts than eating local food as long as I use common sense of eating freshly cooked food at busy places that locals eat at too. 

I don't really eat much farang food these days in Thailand and am sick much less frequently but that's because I am very selective with which local food I go for. I always make sure it's cooked fresh even then, never go for the pre-cooked kebabs or sausages etc. 

On longer trips to Thailand I'm a bit less paranoid about where I can eat due to having adjusted and have no worries about eating at good khao gaeng places where the food is cooked in advance. However it has to be a good and busy place where the food doesn't last long. I certainly wouldn't do that at a random place.

One other thing: despite being a seafood lover I often have to avoid seafood as I'm not sure it's fresh or handled well. I only eat seafood in places that are busy, know what they're doing and you know that they will not be keeping seafood overnight etc. That comes from painful experience of some of the worst types of food poisoning.

As Taas said water is the key thing to watch out for. On shorter trips to Thailand (before I've adjusted and probably got sick in the process) I'm even very cautious about accidentally drinking water from showers and baths even though both are awkward if shared with a LB though.

 

[steve54 464]

1 hour ago, taaseesanuk said:

Personally, if i get the shits I find it's best to do nothing to start. If it still persists after 48hrs I will take an Imodium, this always sorts it out.

In general, the main reason for dodgy guts is the cooking oil which is over used and richer than we are used to, the climate as well has an impact plus

the rigors of travel and eating at times we wouldn't normally due to the change in time zones, throw in the spices and other ingredients we also don't generally consume.

Yes, food poisoning can often be a reason, Thai's generally wash up with cold water as well, but if you are sensible and only eat what you can see being cooked fresh then

most of it can be avoided. Cheap street food that is set aside to sell having been cooked is a real red flag.

Finally, don't use tap water to clean your teeth, I know many people that say they do this but don't swallow it, I think you will always have some work it's way down and this

is a steadfast way to get a dodgy stomach.

I am paranoid about water, brush my teeth with bottled water, rince the tooth brush with it as well. Perhaps I am just dlicate

[steve54 464]

36 minutes ago, Genghis said:

This might be an unpopular suggestion but one of my rules for staying healthy while travelling is to avoid hotel buffet breakfasts.

Fresh cooked eggs are the one exception I occasionally make but otherwise I just steer clear. I've been sick more from hotel breakfasts than eating local food as long as I use common sense of eating freshly cooked food at busy places that locals eat at too. 

I don't really eat much farang food these days in Thailand and am sick much less frequently but that's because I am very selective with which local food I go for. I always make sure it's cooked fresh even then, never go for the pre-cooked kebabs or sausages etc. 

On longer trips to Thailand I'm a bit less paranoid about where I can eat due to having adjusted and have no worries about eating at good khao gaeng places where the food is cooked in advance. However it has to be a good and busy place where the food doesn't last long. I certainly wouldn't do that at a random place.

One other thing: despite being a seafood lover I often have to avoid seafood as I'm not sure it's fresh or handled well. I only eat seafood in places that are busy, know what they're doing and you know that they will not be keeping seafood overnight etc. That comes from painful experience of some of the worst types of food poisoning.

As Taas said water is the key thing to watch out for. On shorter trips to Thailand (before I've adjusted and probably got sick in the process) I'm even very cautious about accidentally drinking water from showers and baths even though both are awkward if shared with a LB though.

 

I try to avoid jiuces and ice as well, stick to drinks froma sealed bottle or can, I don't have breakfast at the hotels, most often a late start and pancakes at a local cafe. 

[Genghis 2,984]

15 minutes ago, steve54 said:

I try to avoid jiuces and ice as well, stick to drinks froma sealed bottle or can, I don't have breakfast at the hotels, most often a late start and pancakes at a local cafe. 

After a while there's only so much we can do to avoid being sick, especially if one of the focus of your trips is having as much sex as possible.

Good luck staying well on your next trip Steve but most of all I hope you have a lot of fun and made plenty of excellent memories even though that means we have to take the bad along with the good occasionally.

[steve54 464]

36 minutes ago, Genghis said:

After a while there's only so much we can do to avoid being sick, especially if one of the focus of your trips is having as much sex as possible.

Good luck staying well on your next trip Steve but most of all I hope you have a lot of fun and made plenty of excellent memories even though that means we have to take the bad along with the good occasionally.

I will do as much as I can to stay well and reduce the risks, but I am going to do what I'm going to do and if I get sick I will be disapointed but just deal with it like I have in the past.

My main hope is that if I do get sick it's short term and curable (food poisoining, crabs or the like), rather than treatable but not curable (AIDs, Hepatitus) I have been vacinated for a much as I can and take PREP and DoxyPEP when in Thailand  

[Denbosch1971 7,787]

4 hours ago, steve54 said:

I will do as much as I can to stay well and reduce the risks, but I am going to do what I'm going to do and if I get sick I will be disapointed but just deal with it like I have in the past.

My main hope is that if I do get sick it's short term and curable (food poisoining, crabs or the like), rather than treatable but not curable (AIDs, Hepatitus) I have been vacinated for a much as I can and take PREP and DoxyPEP when in Thailand  

Didn't have a similar problem for quite a while. But what works like a miracle for me is drinking a Coke (to stabilize stomach PH) and eat a huge well done steak!! 

Not the worst remedy 

[Bwana_LB 2,960]

6 minutes ago, Denbosch1971 said:

But what works like a miracle for me is drinking a Coke (to stabilize stomach PH) and eat a huge well done steak!! 

Well done steaks are a crime against humanity!

[NaamBlaa 9]

Sometimes ciproflaxacin will clear prolonged symptoms at least for me.  Cipro was first recommended and prescribed to me by my doctor ahead of my first trip (along with a typhoid vaccine).  I usually don't have issues however over the three years that I lived in LoS it occasionally happened.  When it did cipro almost always did the trick.

During my three years in LoS I also learned to be very careful with dairy products.  As anyone who has visited a Thai market has probably noticed, Thai people have very casual attitudes when it comes to refrigerating food.  On several occasions I've had GI issues after eating cheeses, yogurt etc from Tops, Big C etc. - places you'd think would be safe.  My take was that just because something is cold in the deli case doesn't mean it didn't sit out on the loading dock in 90+ degree heat for a few hours.

[Unavowed 1,443]

Sometimes ciproflaxacin will clear prolonged symptoms at least for me.  Cipro was first recommended and prescribed to me by my doctor ahead of my first trip (along with a typhoid vaccine).  I usually don't have issues however over the three years that I lived in LoS it occasionally happened.  When it did cipro almost always did the trick.
During my three years in LoS I also learned to be very careful with dairy products.  As anyone who has visited a Thai market has probably noticed, Thai people have very casual attitudes when it comes to refrigerating food.  On several occasions I've had GI issues after eating cheeses, yogurt etc from Tops, Big C etc. - places you'd think would be safe.  My take was that just because something is cold in the deli case doesn't mean it didn't sit out on the loading dock in 90+ degree heat for a few hours.

I had a Thai doctor prescribe Norfloxacin 400 some years ago and when I asked a pharmacist for this time ago he recommended Ciprofloxacin as this was a more potent antibiotic for more persistent cases.

With the changes in time zone, more boozing, different food etc stomach issues are not uncommon but avoid antibiotics unless it really is persistent.

Another good option are charcoal tablets you can pick up from 7/11 which is helpful to settle your stomach after a rough night!

[steve54 464]

11 hours ago, Unavowed said:

I had a Thai doctor prescribe Norfloxacin 400 some years ago and when I asked a pharmacist for this time ago he recommended Ciprofloxacin as this was a more potent antibiotic for more persistent cases.

With the changes in time zone, more boozing, different food etc stomach issues are not uncommon but avoid antibiotics unless it really is persistent.

Another good option are charcoal tablets you can pick up from 7/11 which is helpful to settle your stomach after a rough night!

I have used antibiotics both times previously as 2 days and imodium were just not doing the job, what I hope to be able to do is avoid the symptoms from day 1

[steve54 464]

15 hours ago, Denbosch1971 said:

Didn't have a similar problem for quite a while. But what works like a miracle for me is drinking a Coke (to stabilize stomach PH) and eat a huge well done steak!! 

Not the worst remedy 

Last 2 times I struggled to eat anything other than toast and brought real food back in over a few days.

[Harley_Rider 19]

I travel with Imodium and chewable Pepto-Bismol, and as pointed out above, try not to use them for day or two.  I had real bad diarrhea on a trip to the Philippines, and there was a Dr. on the team. He said, try not to take anything for a day or two, your body is trying to get rid of something, so let it.  He said stay hydrated and try plain crackers.

 

Edited December 1 by Harley_Rider

[CanadaVisitor 886]

I didn't know about ETEC so will look into it.  Thanks for the info @steve54.

I avoid high risk foods and try not to rim.  The first night when I took Judy she presented herself to me and pretty much begged me to rim her so I couldn't say no.  Even though she just cleaned herself in the shower I gave her a wipe down with a baby wipe and then cleaned those soaps/chemicals off with a bit of coconut oil.

I find immodium the best for light cases of diahhrea, but what has made the biggest difference for me is to get onto a probiotic regimine.  I highly suggest this.  

[happyone 57]

On 11/29/2025 at 8:15 PM, steve54 said:

I am paranoid about water, brush my teeth with bottled water, rince the tooth brush with it as well. Perhaps I am just dlicate

I do the same even though Bangkok water is actually chlorinated buuuuut there’s meant to be a residual chlorine level in the condo/hotel water tanks and they don’t seem to ever check this until things like an unusual number of people from the same condo all go to doctors for skin conditions etc.  Seems some condos never ever clean the tanks..

 

I always found the Thai ‘flying rabbit’ and eating white bread and potatoes for a few days clogs me up again nicely.

 

[MarkSussex 1,220]

Will spare the life story version - and as experienced in a brutal way back in late 2019 in Chengdu; hotel air conditioning units. A hotbed for bacteria, mold and viruses if poorly maintained. The hotel staff in Chengdu -just before this COVID thing became a thing- shared that’s how bird-flu spread at the time in 2013. Room to room through aircon units. God I was ill at the time. Pain in the arse was that I was stopping via Bangkok on the way back to London and was seeing Lizzy regularly at the time. She was in a playful “take vids of me in the bathtub mood’ that night ….and was just lying there sweating myself through a fever. 

Stayed in a shittty Holiday Inn in Delhi last weekend courtesy of Putin block booking the whole ITC Maurya. 3 days later I find myself medicine shopping at Delhi’s domestic terminal before heading off to Chennai. That aircon unit would only work on full blast, and on a freezing setting. Clearly poorly maintained. 

Also, be wary of fruit in certain places, especially oranges etc. I have had some my crew in the past falling ill as the fruit was injected with (dirty) water to make it look more fresh/juicy (Accra, Banjul etc)
 

30 years in aviation and 200+ nights in hotels a year makes me go for a pizza these days (in certain places) without feeling any cultural shame. 

 

[steve54 464]

3 hours ago, MarkSussex said:

Also, be wary of fruit in certain places, especially oranges etc. I have had some my crew in the past falling ill as the fruit was injected with (dirty) water to make it look more fresh/juicy (Accra, Banjul etc)
 

Wow, that's a new one for me. I would eat any fruit I could peel and feel safe - perhaps not.

[MarkSussex 1,220]

27 minutes ago, steve54 said:

Wow, that's a new one for me. I would eat any fruit I could peel and feel safe - perhaps not.

Don’t worry about it too much! - we encountered it in places like the Gambia and Lome close to the crew hotels where the roadside vendors would approach you. We were easy targets!  Most places are absolutely fine. Much bigger things to worry about. 

That said, it also explains why the chicken breast looks so huge when you buy it in the supermarket and then shrinks to a 1/3rd of its size when cooking it - the saltwater solution/plumbing effect.