From the Guidelines
For a 15-year-old patient with vomiting, diarrhea, fever, and abdominal cramps after traveling to Jamaica, azithromycin is the most appropriate antibiotic choice. The recommended dosage is a single 1-gm dose or 500 mg daily for 3 days 1. Azithromycin is effective against common pathogens causing traveler's diarrhea, such as enterotoxigenic E. coli, Campylobacter, and Shigella, which are prevalent in the Caribbean region.
- Key considerations for selecting azithromycin include its efficacy, safety profile, and simplicity of treatment regimen.
- Azithromycin has been shown to be superior to levofloxacin in achieving clinical cure in settings with high rates of fluoroquinolone-resistant Campylobacter spp. 1.
- Before starting antibiotics, it's essential to ensure the patient stays hydrated with oral rehydration solutions and electrolyte replacement.
- The patient should avoid dairy products, spicy foods, and caffeine during recovery to minimize gastrointestinal irritation.
- If symptoms persist beyond 5-7 days or if there's significant blood in the stool, further evaluation, including stool cultures, may be necessary 1. Some of the evidence may not be directly related to the question, such as the guidelines for preventing opportunistic infections among HIV-infected persons 1, and is therefore not considered in this recommendation.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Antibiotic Choice for Traveler's Diarrhea
The patient's symptoms, including vomiting, diarrhea, fever, and abdominal cramps, after traveling to Jamaica, suggest a case of traveler's diarrhea. The choice of antibiotic should take into consideration the travel destination and the potential pathogens involved.
Potential Pathogens and Antibiotic Resistance
- The patient's symptoms could be caused by various bacterial pathogens, including enterotoxigenic Escherichia coli, Shigella, Salmonella, and Campylobacter 2, 3, 4.
- Fluoroquinolone resistance, particularly among Campylobacter spp., is a concern in some regions, which may affect the choice of antibiotic 2.
Recommended Antibiotics
- Azithromycin is the preferred first-line antibiotic for the treatment of acute watery diarrhea, febrile diarrhea, and dysentery, with a single dose of 500 mg or 1,000 mg, respectively 2, 5.
- Levofloxacin and ciprofloxacin are alternative options for acute watery diarrhea and febrile diarrhea/dysentery, but their use is limited by increasing fluoroquinolone resistance 2, 3, 4, 6.
- Rifaximin is another alternative for acute watery diarrhea, but it should not be used with invasive illness 2.