From the Guidelines
The recommended treatment dose of azithromycin for travelers' diarrhea is a single 1-gm dose or 500 mg daily for 3 days. This dosage is based on the latest evidence from the Journal of Travel Medicine, which suggests that azithromycin is the first-line agent for cases of dysentery and acute watery diarrhea with greater than mild fever, due to its efficacy against FQ-resistant Campylobacter and other bacterial causes 1. The study found that azithromycin has equivalent efficacy to fluoroquinolones (FQs) in treating watery noninvasive diarrhea, but is superior in achieving clinical cure in settings with high rates of FQ-resistant Campylobacter spp.
Some key points to consider when prescribing azithromycin for travelers' diarrhea include:
- Azithromycin is generally well tolerated with minimal side effects, usually dose-related gastrointestinal complaints 1
- Incident or worsening nausea or vomiting are exacerbated by the primary gastrointestinal infection, and are more common than in the treatment of non-gastrointestinal infections, with rates of 3% and <1%, respectively 1
- Comparable efficacy may be achieved with potentially lower side effect rates, by splitting the single 1-gm dose over the first day; however, this remains to be proven 1
- Azithromycin is particularly effective against bacterial causes of travelers' diarrhea, including Campylobacter, Shigella, and enterotoxigenic E. coli 1
It's also important to note that while taking azithromycin, patients should stay hydrated by drinking plenty of fluids to replace lost water and electrolytes. Common side effects may include nausea, abdominal pain, and diarrhea. Azithromycin is generally preferred for travelers' diarrhea in regions with high fluoroquinolone resistance or for pregnant women and children where fluoroquinolones are contraindicated. Treatment should be accompanied by proper food and water precautions to prevent reinfection during travel.
From the Research
Treatment Dose of Azithromycin for Travelers' Diarrhea
- The recommended treatment dose of azithromycin for travelers' diarrhea varies across studies, with doses ranging from 500 mg to 1000 mg 2, 3, 4, 5.
- A study published in 2017 found that a single-dose of 500 mg azithromycin was effective in treating travelers' diarrhea, with a clinical cure rate of 78.3% at 24 hours 2.
- Another study published in 2007 found that a single-dose of 1000 mg azithromycin was as effective as a single-dose of 500 mg levofloxacin in treating travelers' diarrhea, with similar clinical cure rates and time to last unformed stool 3.
- A study published in 2007 in Thailand found that a single-dose of 1000 mg azithromycin was more effective than a 3-day regimen of 500 mg levofloxacin in treating travelers' diarrhea, with a higher clinical cure rate and shorter time to last unformed stool 4.
- A study published in 2007 in Mexico found that a single-dose of 500 mg azithromycin plus loperamide was more effective than azithromycin alone in treating travelers' diarrhea, with a shorter duration of diarrhea and fewer unformed stools 5.
- A clinical review published in 2019 recommends azithromycin as a treatment option for moderate to severe travelers' diarrhea, with a dose of 500 mg to 1000 mg 6.
Azithromycin Dose Comparison
- The studies suggest that a dose of 500 mg to 1000 mg azithromycin is effective in treating travelers' diarrhea, with similar clinical cure rates and time to last unformed stool 2, 3, 4, 5.
- The choice of dose may depend on the severity of the diarrhea, the presence of bloody stools, and the patient's medical history 6.
- Loperamide may be added to azithromycin to reduce the duration and severity of diarrhea, especially in cases of mild to moderate travelers' diarrhea 5, 6.