What antibiotics are recommended for travel to Turkey and Greece?

Recommended Antibiotics for Travel to Turkey and Greece

For travel to Turkey and Greece, azithromycin is the preferred antibiotic to carry for self-treatment of moderate to severe traveler's diarrhea, with a recommended dosage of 1000mg as a single dose or 500mg daily for 3 days. 1

Understanding Traveler's Diarrhea and Prevention

Traveler's diarrhea is a common concern when visiting countries like Turkey and Greece. While prevention is always better than treatment, carrying appropriate antibiotics is recommended for self-treatment if needed.

Prevention Strategies:

• Avoid high-risk foods and beverages:

  • Raw fruits and vegetables (unless peeled by yourself)
  • Raw or undercooked seafood or meat
  • Tap water and ice made from tap water
  • Unpasteurized dairy products
  • Street vendor foods 2

• Safe food and beverage choices:

  • Steaming hot foods
  • Self-peeled fruits
  • Bottled beverages (including carbonated drinks)
  • Hot coffee and tea
  • Beer and wine
  • Water boiled for 1-2 minutes 2

Antibiotic Recommendations

When to Use Antibiotics:

• Mild diarrhea (tolerable, doesn't interfere with activities):

  • Antibiotics NOT recommended 2
  • Consider loperamide or bismuth subsalicylate instead 2

• Moderate diarrhea (distressing, interferes with activities):

  • Antibiotics may be used 2
  • Consider combining with loperamide for faster relief 1

• Severe diarrhea (incapacitating or bloody stools):

  • Antibiotics should be used 2
  • Azithromycin is preferred 2, 1

Specific Antibiotic Choices:

1. Azithromycin (First Choice):

   • Dosage: 1000mg single dose or 500mg daily for 3 days 1
   • Advantages:
     • Effective against invasive pathogens
     • Works against fluoroquinolone-resistant strains
     • Preferred for dysentery (bloody diarrhea) 1
     • Better safety profile for most travelers 1

2. Rifaximin (Alternative for non-dysenteric cases):

   • Not recommended for bloody diarrhea or fever 1
   • Only effective for non-invasive diarrhea 1
   • High failure rates (up to 50%) against invasive pathogens 1

3. Fluoroquinolones (e.g., ciprofloxacin):

   • No longer first-line due to increasing resistance 1
   • Particularly high resistance in regions including Turkey 1
   • If used, ciprofloxacin 500mg twice daily for 3-7 days 2

Important Considerations

Prophylactic Use:

• Routine antimicrobial prophylaxis is NOT recommended for most travelers 2
• Only consider for travelers at high risk of health complications 2
• If prophylaxis is indicated, rifaximin is preferred over fluoroquinolones 2

Special Populations:

• Pregnant women: Azithromycin is preferred due to safety profile 1
• Children: Antibiotic dosages should be adjusted based on weight 1
• Immunocompromised travelers: May require longer treatment duration 1

When to Seek Medical Care:

• Symptoms persisting beyond 3-5 days despite treatment
• High fever
• Significant dehydration
• Severe abdominal pain
• Bloody stools that don't improve with treatment 1

Treatment Algorithm

1. For mild diarrhea:

   • Use loperamide or bismuth subsalicylate
   • Stay hydrated with safe fluids
   • No antibiotics needed

2. For moderate diarrhea without blood/fever:

   • Azithromycin 1000mg single dose OR
   • Rifaximin (if available and non-invasive diarrhea suspected)
   • Can combine with loperamide for symptom relief

3. For severe diarrhea or dysentery:

   • Azithromycin 1000mg single dose or 500mg daily for 3 days
   • Do NOT use loperamide if high fever or bloody stools 2
   • Maintain hydration with oral rehydration solutions

Remember that rehydration remains the cornerstone of therapy for all cases of traveler's diarrhea, regardless of severity 1.