From the Guidelines
Azithromycin is the recommended first-line treatment for traveller's diarrhea, particularly in cases of dysentery or acute watery diarrhea with greater than mild fever, due to its high efficacy and safety profile. The decision to treat traveller's diarrhea with azithromycin is based on the assessment of the severity of illness and the effects it will have on the traveler's activities and plans 1.
Key Considerations
- Azithromycin has been shown to be superior to levofloxacin in achieving clinical cure in settings with high rates of fluoroquinolone-resistant Campylobacter spp. 1
- The recommended dosage of azithromycin is a single 1-gm dose or 500 mg daily for 3 days 1
- Azithromycin is generally well tolerated with minimal side effects, usually dose-related gastrointestinal complaints 1
- The use of azithromycin is particularly recommended in regions with high rates of fluoroquinolone-resistant pathogens, such as Southeast Asia 1
Benefits of Azithromycin
- High efficacy in treating traveller's diarrhea caused by bacterial pathogens, including Campylobacter, Shigella, and enterotoxigenic Escherichia coli (ETEC) 1
- Rapid symptom resolution, with a reduction in symptom duration from an average of 50-93 to 16–30 hours 1
- Safety profile, with minimal side effects and low risk of adverse effects 1
Comparison to Other Treatments
- Azithromycin has been shown to be equivalent in efficacy to fluoroquinolones (FQs) and rifaximin in the treatment of watery noninvasive diarrhea 1
- However, azithromycin is preferred over FQs in cases of dysentery or acute watery diarrhea with greater than mild fever due to the increasing prevalence of FQ-resistant Campylobacter spp. 1
From the Research
Role of Azithromycin in Treating Traveller's Diarrhoea
- Azithromycin is a macrolide antibiotic that has been found to be effective in treating traveller's diarrhoea 2, 3, 4, 5.
- It is currently the preferred first-line antibiotic for the treatment of acute watery diarrhoea, as well as for febrile diarrhoea and dysentery 2.
- The recommended dose of azithromycin for traveller's diarrhoea is a single dose of 500 mg for acute watery diarrhoea, and a single dose of 1,000 mg for febrile diarrhoea and dysentery 2.
- Azithromycin has been shown to be effective in reducing the severity and duration of traveller's diarrhoea, and is particularly useful in areas where fluoroquinolone resistance is high 2, 4.
- It can be used in combination with loperamide to further reduce gastrointestinal symptoms and duration of illness 2, 5.
Comparison with Other Antibiotics
- Azithromycin is considered a better option than fluoroquinolones in areas with high rates of Campylobacter spp. resistance 2, 4.
- Rifaximin is another alternative for acute watery diarrhoea, but it should not be used with invasive illness 2, 4.
- Doxycycline and trimethoprim-sulfamethoxazole are also options, but their use is limited due to increasing resistance 3, 4.
Treatment Guidelines
- For mild traveller's diarrhoea, the use of antibiotics is not recommended, and bismuth subsalicylate or loperamide may be considered instead 5.
- For moderate traveller's diarrhoea, antibiotics such as azithromycin, fluoroquinolones, and rifaximin may be used, with loperamide as monotherapy or adjunctive therapy 5.
- For severe traveller's diarrhoea, antibiotics such as azithromycin, fluoroquinolones, and rifaximin should be used, with azithromycin being the preferred option for dysentery 5.