What antibiotics are associated with the least amount of diarrhea (gastrointestinal disturbance)?

From the Guidelines

Azithromycin is the antibiotic associated with the least amount of diarrhea due to its high efficacy and favorable safety profile, as demonstrated in a study published in the Journal of Travel Medicine in 2017 1. When considering the treatment of travelers' diarrhea, the selection of an empiric antibiotic should be based on factors such as the likelihood of treatment efficacy, regional patterns of probable target pathogens, and the safety and tolerance profile of the antibiotic. Key points to consider include:

• Azithromycin has been shown to be superior to levofloxacin in achieving clinical cure in settings with high rates of fluoroquinolone-resistant Campylobacter spp. 1
• Azithromycin is generally well tolerated with minimal side effects, usually dose-related gastrointestinal complaints, with rates of nausea or vomiting being around 3% and <1%, respectively 1
• The use of fluoroquinolones, such as ciprofloxacin, is associated with a higher risk of adverse effects, including gastrointestinal side effects, Achilles tendon rupture, and an increased risk for C. difficile infection 1
• Rifaximin, a nonabsorbable antibiotic, has demonstrated comparable efficacy to fluoroquinolones in non-invasive travelers' diarrhea caused by diarrheagenic E. coli, but is less effective for the treatment of invasive pathogens 1 In terms of minimizing the risk of diarrhea, it is essential to choose an antibiotic that is effective against the suspected pathogen while also being gentle on the gut flora. Some factors to consider when selecting an antibiotic include:
• The antibiotic's spectrum of activity and its potential to disrupt the balance of normal gut bacteria
• The regional patterns of antimicrobial resistance and the likelihood of treatment efficacy
• The safety and tolerance profile of the antibiotic, including the risk of adverse effects such as gastrointestinal disturbances By considering these factors and choosing an antibiotic like azithromycin, which has a favorable safety profile and high efficacy, the risk of diarrhea can be minimized.