Objective: Devise and implement evidence based guidelines for the prevention and management of travellers’ diarrhoea (TD), and establish the incidence of TD during an elite sporting trip to India.
Design: Literature review and audit.
Setting: Youth Commonwealth Games in India 2008.
Participants: All members of the Team England Squad.
Main outcome measures: Hygiene guidelines included only drinking bottled water, eating hot food and regular hand washing with alcohol gel. Ciprofloxacin was offered to non athlete team members as prophylaxis but not to athletes due to its possible association with tendon disease. Following implementation of these guidelines, the incidence of TD in the whole squad was 24/122 (20%), compared with 7/14 (50%) on the reconnaissance trip (pre guidelines). In those taking prophylactic ciprofloxacin the incidence was 4/33 (12%), compared with 20/89 (23%) in those not taking ciprofloxacin. No athlete missed their event due to TD.
Conclusions: Implementation of strict hygiene guidelines reduced the incidence of TD. Prophylactic ciprofloxacin also reduced the incidence of TD but it is probably not appropriate for use in elite athletes. Rifaximin may be an alternative for this group.
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