From the Guidelines
Traveler's diarrhea is best treated with loperamide (Imodium) 4mg initially followed by 2mg after each loose stool (maximum 16mg daily) for mild cases, while antibiotics such as azithromycin 1000mg as a single dose or 500mg daily for 3 days are recommended for moderate to severe cases, especially in regions with high fluoroquinolone resistance. The causes of traveler's diarrhea include unfamiliar bacteria, particularly enterotoxigenic E. coli, which disrupts normal intestinal function and causes increased fluid secretion into the bowel 1.
Prevention and Treatment
For prevention, practice good hygiene by:
- Washing hands frequently
- Drinking only bottled or purified water
- Avoiding raw foods
- Considering bismuth subsalicylate (Pepto-Bismol) as prophylaxis
If symptoms develop, stay hydrated with oral rehydration solutions like Pedialyte or a homemade mixture of 1 liter of clean water with 6 teaspoons of sugar and 1/2 teaspoon of salt.
Antibiotic Treatment
Antibiotics are effective for moderate to severe cases, with azithromycin being the preferred option, especially in regions with high fluoroquinolone resistance 1. Ciprofloxacin 500mg twice daily for 1-3 days is an alternative in areas with low resistance.
Seeking Medical Attention
Most cases resolve within 3-5 days without treatment, but seek medical attention if you experience:
- High fever
- Bloody stools
- Severe abdominal pain
- Symptoms persisting beyond a week
The increasing antibiotic resistance among enteropathogens causing traveler's diarrhea requires continued surveillance and reconsideration of practice guidelines 1.
From the FDA Drug Label
XIFAXAN is indicated for the treatment of travelers’ diarrhea (TD) caused by noninvasive strains of Escherichia coli in adults and pediatric patients 12 years of age and older XIFAXAN should not be used in patients with diarrhea complicated by fever or blood in the stool or diarrhea due to pathogens other than Escherichia coli The recommended dose of XIFAXAN is one 200 mg tablet taken orally three times a day for 3 days
The causes of traveler's diarrhea (TD) that are relevant to the use of XIFAXAN are:
- Noninvasive strains of Escherichia coli The treatments for TD are:
- XIFAXAN (rifaximin) 200 mg orally three times a day for 3 days Limitations of XIFAXAN use in TD:
- Not effective in patients with diarrhea complicated by fever or blood in the stool
- Not effective in diarrhea due to pathogens other than Escherichia coli, such as Campylobacter jejuni, Shigella spp., or Salmonella spp. 2 2
From the Research
Causes of Traveler's Diarrhea
- Common pathogens in traveler's diarrhea include enterotoxigenic Escherichia coli, Campylobacter, Shigella, Salmonella, Yersinia, and many other species 3
- Viruses and protozoa are also causes of traveler's diarrhea 3
- Food and water contaminated with fecal matter are the main sources of infection 4
- Travel destination is the most significant risk factor for traveler's diarrhea 4
Prevention of Traveler's Diarrhea
- Carefully selecting foods and beverages can help avoid traveler's diarrhea 3
- Precautions can be taken to minimize the risk of developing traveler's diarrhea, either through avoidance of potentially contaminated food or drink or through various prophylactic measures 5
- Prophylactic antibiotics are very effective in prevention, but are recommended only for specific at-risk individuals and are contraindicated for most travelers 6
Treatments of Traveler's Diarrhea
- Treatment with loperamide (in the absence of dysentery) and a fluoroquinolone, such as ciprofloxacin, is usually safe and effective in adults with traveler's diarrhea 3
- Azithromycin and new fluoroquinolones show promise as possible replacements for older agents 3
- Rifaximin, a recently approved antibiotic, can be used for the treatment of traveler's diarrhea in regions where noninvasive E. coli is the predominant pathogen 4
- Single-dose azithromycin, levofloxacin, and rifaximin with loperamide were comparable for treatment of acute watery diarrhea 7