From the Guidelines
The treatment for traveller's diarrhea primarily involves oral rehydration therapy and, in severe cases, antibiotics such as azithromycin (500mg once daily for 1-3 days) which is the most commonly recommended due to its efficacy and lower resistance rates compared to fluoroquinolones 1. For mild cases, oral rehydration therapy with safe fluids like bottled water, oral rehydration solutions, or clear broths, along with a temporary diet of bland, easy-to-digest foods, may be sufficient.
- Antimotility agents like loperamide (Imodium) can help reduce the frequency of bowel movements at a dose of 4mg initially, followed by 2mg after each loose stool (maximum 16mg daily).
- Bismuth subsalicylate (Pepto-Bismol) at 30ml or 2 tablets every 30 minutes up to 8 doses can also help. However, for severe or persistent diarrhea, antibiotics are necessary, with azithromycin being preferred over fluoroquinolones due to increasing resistance rates globally 1. It's crucial to seek medical attention if symptoms include high fever, bloody stools, severe abdominal pain, or if diarrhea persists beyond 3-5 days despite treatment. The choice of antibiotic should consider the likelihood of treatment efficacy, regional patterns of probable target pathogens and their antimicrobial resistance, safety and tolerance profile of the antibiotic, simplicity of treatment regimen, and cost 1. Given the emergence of multidrug-resistant bacteria, the potential for drug interactions, and the side effects associated with fluoroquinolones, azithromycin stands out as a safer and more effective option for the treatment of traveller's diarrhea 1.
From the FDA Drug Label
Treatment of diarrhea with loperamide hydrochloride is only symptomatic. Whenever an underlying etiology can be determined, specific treatment should be given when appropriate (or when indicated).
The treatment for traveller's diarrhea with loperamide is symptomatic.
- Loperamide is used to treat the symptoms of diarrhea, but it does not treat the underlying cause.
- If the underlying cause of the diarrhea can be determined, specific treatment should be given when appropriate.
- Fluid and electrolyte therapy is also important in patients with diarrhea to prevent dehydration. 2
From the Research
Treatment for Traveller's Diarrhea
The treatment for traveller's diarrhea typically involves a combination of antibiotics and loperamide to rapidly resolve symptoms 3, 4, 5, 6.
- Antibiotics: Fluoroquinolones, azithromycin, and rifaximin are commonly used antibiotics for the treatment of traveller's diarrhea 3, 4, 5.
- Loperamide: Loperamide is an antimotility agent that can be used alone or in combination with antibiotics to treat traveller's diarrhea 3, 4, 5, 6.
- Treatment Duration: The duration of treatment for traveller's diarrhea can vary depending on the severity of symptoms and the specific antibiotic used 3, 4, 5.
- Mild Cases: For mild cases of traveller's diarrhea, treatment may involve simply maintaining hydration, and the use of bismuth subsalicylate or loperamide may be considered 5, 7.
- Moderate Cases: For moderate cases, antibiotics such as fluoroquinolones, azithromycin, and rifaximin may be used, and loperamide may be considered as monotherapy or adjunctive therapy 5, 7.
- Severe Cases: For severe cases, antibiotics such as azithromycin, fluoroquinolones, and rifaximin should be used, and azithromycin can be used even for the treatment of dysentery whereas fluoroquinolones and rifaximin cannot be used for such purpose 5.
Comparison of Treatment Options
Studies have compared the efficacy of different treatment options for traveller's diarrhea, including:
- Azithromycin vs. Levofloxacin: Azithromycin and levofloxacin were found to be comparable in terms of efficacy for the treatment of traveller's diarrhea 3, 4.
- Rifaximin vs. Azithromycin and Levofloxacin: Rifaximin was found to be less effective than azithromycin and levofloxacin for the treatment of traveller's diarrhea 3.
- Loperamide plus Azithromycin vs. Azithromycin Alone: The combination of loperamide and azithromycin was found to be more effective than azithromycin alone for the treatment of traveller's diarrhea 6.