From the Guidelines
Ciprofloxacin (Cipro) is not the first-line treatment for traveler's diarrhea due to increasing resistance rates, and azithromycin is recommended as the first-line agent, especially in cases of dysentery or severe diarrhea. The decision to treat traveler's diarrhea with an antimicrobial agent is based on the severity of illness and its impact on the traveler's activities and plans. According to the guidelines for the prevention and treatment of travelers' diarrhea 1, antibiotics have been shown to reduce symptom duration in traveler's diarrhea, but the choice of antibiotic should be based on regional patterns of probable target pathogens and their antimicrobial resistance.
Key considerations in the selection of an empiric antibiotic include the likelihood of treatment efficacy and rapidity of response, regional patterns of probable target pathogens and their antimicrobial resistance, safety and tolerance profile of the antibiotic, simplicity of treatment regimen, and cost. Azithromycin has been shown to be superior to levofloxacin in achieving clinical cure in Thailand, where there are high rates of fluoroquinolo-resistant Campylobacter spp. 1.
The typical adult dosage of azithromycin for traveler's diarrhea is a single 1-gm dose or 500 mg daily for 3 days. While ciprofloxacin may still be effective in some cases, its use is limited by the increasing resistance rates, and it is not recommended as the first-line treatment. Azithromycin is generally well tolerated with minimal side effects, and its use is recommended over ciprofloxacin due to its superior efficacy and safety profile. If symptoms persist beyond 3-4 days of treatment, or include high fever, severe abdominal pain, or bloody stools, medical attention should be sought as this may indicate a more serious infection requiring different treatment 1.