What is the treatment for traveler's diarrhea (TD)?

From the Guidelines

Travelers' diarrhea can be effectively treated with oral rehydration and antibiotics, with azithromycin being the first choice for moderate to severe cases, as recommended by the most recent and highest quality study 1. The primary approach to treating travelers' diarrhea should include oral rehydration using solutions like Pedialyte or a homemade mixture of 1 liter of clean water with 6 teaspoons of sugar and 1/2 teaspoon of salt. For symptom relief, loperamide (Imodium) can be taken at a dose of 4mg initially, followed by 2mg after each loose stool, not exceeding 16mg daily, as supported by the study 1. Antibiotics are recommended for moderate to severe cases, with azithromycin (1000mg single dose or 500mg daily for 3 days) being the first choice, or ciprofloxacin (500mg twice daily for 1-3 days) as an alternative, as stated in the study 1. Some key points to consider when treating travelers' diarrhea include:

• Maintaining hydration throughout the illness
• Seeking medical attention if symptoms persist beyond 3-5 days
• Seeking medical attention if there's blood in the stool, high fever, or severe abdominal pain
• Considering prevention strategies such as careful food and water choices while traveling in high-risk areas, as mentioned in the study 1. It's also important to note that fluoroquinolones, such as ciprofloxacin, should be avoided in children and pregnant women, and alternative antibiotics should be considered, as recommended by the study 1. Overall, the treatment of travelers' diarrhea should prioritize the use of oral rehydration, antibiotics, and symptom relief, while also considering prevention strategies and potential contraindications, as supported by the studies 1.

From the Research

Treatment Options for Traveler's Diarrhea

• The treatment for traveler's diarrhea can vary depending on the severity of the illness, with mild cases often not requiring antibiotic treatment 2.
• For moderate to severe cases, antibiotics such as fluoroquinolones, azithromycin, and rifaximin may be used 2.
• Loperamide may be considered as monotherapy or adjunctive therapy for moderate traveler's diarrhea 2.
• In cases of dysentery, azithromycin can be used, whereas fluoroquinolones and rifaximin cannot be used for this purpose 2.
• The use of bismuth subsalicylate or loperamide may be considered for mild traveler's diarrhea 2.
• Oral rehydration therapy is the mainstay for managing water and electrolyte depletion, especially in infants, children, and the elderly 3, 4.

Prevention and Management

• Pretravel education on hygiene and safe selection of food items is important in minimizing episodes of traveler's diarrhea 2.
• Travelers to high-risk areas should be advised to bring an antidiarrheal compound or bismuth subsalicylate, if available, and an antibacterial agent 3.
• The secretion inhibitor racecadotril is considered a first-choice treatment for acute uncomplicated traveler's diarrhea in some guidelines 5.
• Antibiotics should be used only in complicated cases, and travelers who demand antibiotic therapy should be disabused of their expectations 5.

Recommendations for Pharmacists

• Pharmacists can play a role in counseling travelers on the prevention and treatment of traveler's diarrhea, including recommending medications and providing advice on hygiene and food selection 6.
• Pharmacists should be aware of the current recommendations for the treatment of traveler's diarrhea and be able to advise travelers on the best course of action 6.