What antibiotics are recommended for treating traveler's diarrhea?

From the Guidelines

Azithromycin is the recommended first-line antibiotic for treating traveler's diarrhea, particularly in cases of dysentery or acute watery diarrhea with fever, due to its high efficacy and safety profile, as demonstrated in recent studies 1. When considering antibiotic treatment for traveler's diarrhea, several factors come into play, including the severity of symptoms, the likelihood of treatment efficacy, and regional patterns of antimicrobial resistance.

• The decision to treat traveler's diarrhea with antibiotics should be based on the assessment of the severity of illness and its impact on the traveler's activities and plans.
• Antibiotics have been shown to reduce symptom duration in traveler's diarrhea from an average of 50-93 hours to 16-30 hours 1.
• Azithromycin has been demonstrated 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, which has been shown to be effective and well-tolerated 1.
• Other antibiotics, such as ciprofloxacin and levofloxacin, may also be effective, but their use is limited by the increasing prevalence of fluoroquinolone-resistant bacteria, particularly in Southeast Asia 1.
• Rifaximin, a nonabsorbable antibiotic, has demonstrated comparable efficacy to fluoroquinolones in non-invasive traveler's diarrhea caused by diarrheagenic E. coli, but its use is limited to mild cases and is not effective against invasive pathogens 1.
• It is essential to combine antibiotic treatment with fluid replacement to prevent dehydration, and over-the-counter medications like loperamide can help control symptoms, but should not be used alone for bloody diarrhea or high fever.

From the FDA Drug Label

The provided drug labels do not directly address the treatment of traveler's diarrhea with the mentioned antibiotics, azithromycin, ciprofloxacin, and levofloxacin.

The FDA drug label does not answer the question.

From the Research

Antibiotics for Traveler's Diarrhea

• The recommended treatment for traveler's diarrhea includes the combination of an antibiotic, usually a fluoroquinolone or azithromycin, and loperamide for rapid resolution of symptoms 2.
• Azithromycin, levofloxacin, and rifaximin are comparable for the treatment of acute watery diarrhea, with clinical cure rates at 24 hours of 81.4%, 78.3%, and 74.8%, respectively 2.
• Single-dose azithromycin (1000 mg) and loperamide is as effective as single-dose levofloxacin (500 mg) and loperamide for noninflammatory diarrhea, although azithromycin may cause more nausea after dosing 3.

Comparison of Antibiotics

• Azithromycin was found to be a safe and effective alternative to levofloxacin for the treatment of acute travelers' diarrhea in US adult travelers to Mexico, with similar median times to last unformed stool and treatment failure rates 4.
• A study in Thailand found that single-dose azithromycin (1 g) had a higher cure rate (96%) and shorter median time to last unformed stool (35 h) compared to 3-day azithromycin and levofloxacin regimens 5.

Considerations for Chronic Therapies

• When prescribing medications for traveler's diarrhea, it is essential to consider potential interactions with chronic therapies, such as antidiabetic, antihypertensive, and cardioprotective medications 6.
• Levofloxacin was found to be the safest drug among hypertensive individuals, with no interaction effects with any of the antihypertensive medications, while rifaximin exhibited mild interaction only with metformin 6.