Is Cipro (ciprofloxacin) effective for treating traveler's diarrhea?

Ciprofloxacin for Traveler's Diarrhea

Ciprofloxacin is effective for treating traveler's diarrhea and should be provided as empiric therapy (500 mg twice daily for 3-7 days) to be taken if diarrhea develops during travel to developing countries. 1

Effectiveness of Ciprofloxacin

Ciprofloxacin has demonstrated significant efficacy in treating traveler's diarrhea:

• The FDA has approved ciprofloxacin for infectious diarrhea caused by various pathogens including Escherichia coli (enterotoxigenic strains), Campylobacter jejuni, and several Shigella species 2
• Clinical studies show ciprofloxacin significantly reduces the duration and severity of diarrhea in travelers compared to placebo 3
• A single 500 mg dose of ciprofloxacin has been shown to reduce mean duration of diarrhea from 50.4 hours to 20.9 hours 3
• When used as prophylaxis, ciprofloxacin (500 mg daily) has demonstrated superior effectiveness compared to trimethoprim/sulfamethoxazole, with only 5% of ciprofloxacin users developing diarrhea versus 33% in the placebo group 4

Recommended Treatment Approach

Empiric Therapy (First-Line)

• Provide a prescription for ciprofloxacin 500 mg twice daily for 3-7 days to be taken only if diarrhea develops 5, 1
• Instruct patients to seek medical attention if:
  • Diarrhea is severe and doesn't respond to empiric therapy
  • Blood appears in the stool
  • Fever is accompanied by shaking chills
  • Dehydration develops 5

Alternative Options

• Azithromycin (1000 mg single dose or 500 mg daily for 3 days) is an effective alternative, particularly in areas with high fluoroquinolone resistance like South and Southeast Asia 1, 6
• For children and pregnant women, trimethoprim-sulfamethoxazole may be considered instead of fluoroquinolones 5

Preventive Measures

While antimicrobial prophylaxis is generally not recommended for routine travel 5, travelers should:

• Consume only steaming-hot foods that are thoroughly cooked
• Eat fruits that they peel themselves
• Avoid raw fruits and vegetables, raw or undercooked seafood or meat, and items sold by street vendors
• Drink bottled beverages (especially carbonated ones), hot coffee and tea, beer and wine
• If using tap water, bring it to a rolling boil for 1 minute 5, 1

Adjunctive Therapy

• Antiperistaltic agents like loperamide can be used for mild diarrhea
• Discontinue if symptoms persist beyond 48 hours
• Do not use if high fever or blood in stool is present 5

Special Considerations

Emerging Resistance

• Rising resistance to fluoroquinolones necessitates ongoing surveillance and appropriate antibiotic selection 1
• In areas with high fluoroquinolone resistance, azithromycin may be preferred 1, 6

Immunocompromised Patients

• HIV-infected travelers are at higher risk for foodborne and waterborne infections 5
• For immunocompromised patients with severe illness and bloody diarrhea, empiric antibacterial treatment with azithromycin may be preferred 1

Ciprofloxacin remains a standard treatment for self-therapy of traveler's diarrhea in most regions of the world, with the exception of South and Southeast Asia where azithromycin is preferred due to resistance patterns 6.