What is the recommended dose of amoxicillin (amoxicillin) for traveler's diarrhea?

Amoxicillin is NOT Recommended for Traveler's Diarrhea

Amoxicillin is not recommended for traveler's diarrhea treatment. The first-line antibiotic treatment is azithromycin at 1000mg single dose or 500mg daily for 3 days for moderate to severe cases. 1

Recommended Antibiotic Regimens for Traveler's Diarrhea

According to the most recent clinical guidelines, the following antibiotics are recommended for traveler's diarrhea:

1. First-line treatment:

   • Azithromycin: 1000mg single dose or 500mg daily for 3 days 1
   • Better safety profile compared to fluoroquinolones, especially in pregnant women and children 1

2. Alternative options:

   • Fluoroquinolones: (with caution due to resistance)
     • Ciprofloxacin: 500mg twice daily for 1-3 days 2
     • Levofloxacin: 500mg once daily for 1-3 days 2
   • Rifaximin: 200mg three times daily for 3 days (only for non-invasive, watery diarrhea) 2

Treatment Algorithm

1. Assess severity:

   • Mild: Fewer than 3 unformed stools per day without fever or blood
   • Moderate to severe: 3+ unformed stools per day, with or without fever, blood, or severe abdominal pain

2. Treatment approach:

   • Mild cases: Consider symptomatic treatment with loperamide alone
   • Moderate to severe cases: Antibiotic + loperamide
   • Dysentery (bloody stools): Azithromycin 1000mg single dose 1, 2

3. Special populations:

   • Children: Azithromycin 10mg/kg/day is preferred 1
   • Pregnant women: Azithromycin is the safest option 1

Clinical Efficacy and Evidence

Recent research shows that single-dose antibiotic regimens with loperamide are highly effective for traveler's diarrhea:

• Single-dose azithromycin (500mg) achieved 78.3% clinical cure at 24 hours 3
• Single-dose levofloxacin (500mg) achieved 81.4% clinical cure at 24 hours 3
• Single-dose rifaximin (1650mg) achieved 74.8% clinical cure at 24 hours 3

By 72 hours, all regimens achieved approximately 96% efficacy 3.

Important Considerations and Pitfalls

• Rising resistance: Fluoroquinolone resistance is increasing globally, particularly among Campylobacter species 1, 2
• Avoid amoxicillin: Not mentioned in any current guidelines for traveler's diarrhea treatment
• Rifaximin limitations: Should not be used for invasive illness (fever or bloody stools) 2
• Loperamide caution: Should be discontinued if symptoms persist beyond 48 hours and avoided with high fever or bloody stools 1

Prevention Strategies

In addition to treatment, prevention is critical:

• Consume only thoroughly cooked, hot foods
• Drink bottled beverages, hot coffee/tea, or properly treated water
• Practice frequent handwashing
• Avoid raw fruits/vegetables, undercooked seafood/meat, and street vendor foods 1

Remember that while antibiotic treatment significantly reduces symptom severity and duration, traveler's diarrhea is generally self-limiting and resolves within 5 days 2.