From the Guidelines
Treatment of traveler's diarrhea typically involves oral rehydration, antimotility agents, and antibiotics depending on severity, with azithromycin being the first choice in most regions due to increasing fluoroquinolone resistance. For mild cases, focus on staying hydrated with oral rehydration solutions (ORS) made by mixing 6 teaspoons of sugar and 1/2 teaspoon of salt in 1 liter of clean water, or using commercial products like Pedialyte 1. Loperamide (Imodium) can reduce diarrhea symptoms at a dose of 4 mg initially, followed by 2 mg after each loose stool (maximum 16 mg daily).
Key Considerations for Treatment
- For moderate to severe diarrhea, antibiotics are recommended, with azithromycin (1000 mg single dose or 500 mg daily for 3 days) being the first choice in most regions due to increasing fluoroquinolone resistance 1.
- Ciprofloxacin (750 mg single dose or 500 mg twice daily for 3 days) remains an option in areas without high resistance.
- Rifaximin (200 mg three times daily for 3 days) works well for non-invasive diarrhea.
- Bismuth subsalicylate (Pepto-Bismol, 2 tablets or 30 ml four times daily) can help with mild cases.
Prevention Strategies
- Careful food and water choices (avoiding tap water, raw vegetables, unpeeled fruits, and street food) can help prevent traveler's diarrhea 1.
- Using hand sanitizer is also recommended.
- Considering bismuth subsalicylate prophylaxis for high-risk travelers may be beneficial.
When to Seek Medical Attention
- Most cases resolve within 3-5 days with proper treatment, but seek medical attention if symptoms include high fever, bloody stools, severe abdominal pain, or dehydration signs like decreased urination 1.
From the FDA Drug Label
to contact their healthcare provider if they see blood in their stools, or if they develop a fever or abdominal distention that if clinical improvement is not observed in 48 hours, discontinue loperamide hydrochloride and contact their healthcare provider.
The treatment options for traveler's diarrhea include loperamide to manage symptoms, but patients should be advised to contact their healthcare provider if they experience blood in their stools, fever, or abdominal distention. If clinical improvement is not observed in 48 hours, patients should discontinue loperamide and contact their healthcare provider 2.
From the Research
Treatment Options for Traveler's Diarrhea
- Fluid replacement is the principal therapeutic modality for treating traveler's diarrhea 3
- Antimotility drugs such as loperamide or diphenoxylate can be used to treat moderate forms of traveler's diarrhea 4, 3
- Bismuth subsalicylate can be used for moderate forms of traveler's diarrhea 4, 3
- Antimicrobial agents such as doxycycline, trimethoprim, or trimethoprim-sulfamethoxazole can be used to treat more severe cases of traveler's diarrhea 4, 5, 6, 3
- Fluoroquinolones such as ciprofloxacin can be used to treat traveler's diarrhea in adults 6
- Azithromycin and new fluoroquinolones may be used as possible replacements for older agents 6
Management Strategies for Traveler's Diarrhea
- Educating patients to consume only safe foods and pure water can help prevent traveler's diarrhea 5
- Avoiding high-risk foods and boiling water if a safe water supply is not available can help prevent traveler's diarrhea 5
- Probiotics may be used for the prophylaxis of traveler's diarrhea 7
- Maintaining hydration is important for treating mild cases of traveler's diarrhea 7
- Antibiotics and antimotility agents can be used to treat moderate cases of traveler's diarrhea that disrupt the travel itinerary 7
- Travelers who develop dysentery, high fever, or prolonged diarrhea lasting more than 10-14 days should seek medical attention for specific diagnosis and appropriate antimicrobial therapy 3