From the Guidelines
Azithromycin is the best medication to have on hand for G.I. related infections when traveling to a Third World country, due to its efficacy in treating dysentery and acute watery diarrhea with high fever, as well as its effectiveness against a wide range of bacterial causes, including FQ-resistant Campylobacter and Shigella spp. When considering medication for gastrointestinal infections while traveling, it's essential to prioritize the most effective treatment options. According to the guidelines for the prevention and treatment of travelers' diarrhea, azithromycin has been shown to be superior to levofloxacin in achieving clinical cure in settings with high rates of FQ-resistant Campylobacter spp. 1. Some key points to consider when using azithromycin include:
- A single 1-gm dose or 500 mg daily for 3 days is the recommended regimen
- Azithromycin is generally well tolerated with minimal side effects, usually dose-related gastrointestinal complaints 1
- The medication has demonstrated effective and comparable cure rates with shigellosis, another common agent causing dysentery 1 It's also important to note that while fluoroquinolones (FQs) retain efficacy in much of the developing world, their use is cautioned due to concerns about reduced benefit and significant risk concerns, including the potential for Achilles tendon rupture and an increased risk for C. difficile infection 1. In addition to azithromycin, it's recommended to pack oral rehydration salts to prevent dehydration during episodes of diarrhea. Before traveling, consult with your doctor to get this prescription and discuss any personal health considerations. While taking azithromycin, continue to drink plenty of fluids and avoid potentially contaminated food and water to prevent further infection.
From the Research
Medication Options for G.I. Related Infections
When traveling to a Third World country, it is essential to have medication on hand for G.I. related infections. The following options are recommended:
- For mild travelers' diarrhea, the use of bismuth subsalicylate or loperamide may be considered 2.
- For moderate travelers' diarrhea, antibiotics such as fluoroquinolones, azithromycin, and rifaximin may be used 2, 3.
- For severe travelers' diarrhea, antibiotics such as azithromycin, fluoroquinolones, and rifaximin should be used 2.
- Azithromycin can be used even for the treatment of dysentery, whereas fluoroquinolones and rifaximin cannot be used for such purpose 2.
- Ciprofloxacin is the standard treatment in self-therapy of traveler's diarrhea, except when patients are in South or Southeast Asia, where azithromycin is preferred 3.
Important Considerations
When selecting a medication, it is crucial to consider the severity of the diarrhea and the specific destination. Additionally, pretravel education on hygiene and safe food selection is essential in minimizing episodes of travelers' diarrhea 2, 3.
Treatment Approaches
The treatment approach may vary depending on the individual's specific needs and the severity of the infection. It is essential to consult with a healthcare professional before traveling to determine the best course of treatment. Judicious use of an antimotility agent and antimicrobial therapy can reduce the duration and severity of diarrhea 2.