From the Guidelines
For treating traveler's diarrhea, azithromycin 1000mg as a single dose or 500mg daily for 3 days is the recommended antibiotic treatment, especially in cases of dysentery or severe diarrhea, due to its high efficacy and low resistance rates 1. When managing traveler's diarrhea, it's essential to consider the severity of symptoms and their impact on the traveler's activities.
- For mild cases, oral rehydration with water mixed with oral rehydration salts or a homemade solution of 1 liter water with 6 teaspoons sugar and 1/2 teaspoon salt is crucial.
- Loperamide (Imodium) can be used to reduce the frequency of bowel movements, with a starting dose of 4mg, followed by 2mg after each loose stool, not exceeding 16mg daily 1.
- However, azithromycin is the preferred antibiotic treatment due to its broad-spectrum activity, high efficacy, and low resistance rates, particularly in regions with high fluoroquinolone resistance 1.
- Alternatively, ciprofloxacin 750mg as a single dose or 500mg twice daily for 3 days can be used in regions with low resistance, but its use is limited due to increasing resistance rates 1.
- Bismuth subsalicylate (Pepto-Bismol) can help with milder symptoms, taken as two tablets (262mg each) every 30-60 minutes up to 8 doses daily.
- It's essential to continue eating simple, bland foods like rice, bananas, and toast, while avoiding dairy, caffeine, and alcohol until recovery.
- Medical attention should be sought if symptoms persist or worsen, with signs such as high fever (over 102°F/39°C), bloody stools, severe abdominal pain, or symptoms persisting beyond 3-5 days.
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 The recommended dose of XIFAXAN is one 200 mg tablet taken orally three times a day for 3 days. 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
Treatment of Travelers' Diarrhea:
- Indication: Rifaximin (XIFAXAN) is indicated for the treatment of travelers' diarrhea caused by noninvasive strains of Escherichia coli in adults and pediatric patients 12 years of age and older.
- Dosage: The recommended dose is one 200 mg tablet taken orally three times a day for 3 days.
- Limitations: Rifaximin 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 2, 2, 2.
From the Research
Treatment Options for Traveler's Diarrhea
- The combination of an antibiotic and loperamide is a recommended treatment for traveler's diarrhea 3.
- Azithromycin and levofloxacin are comparable in treating traveler's diarrhea when combined with loperamide 3.
- Loperamide can be used to relieve symptoms such as abdominal discomfort, nausea, and vomiting, while antibiotics like trimethoprim-sulfamethoxazole (TMP-SMX) or fluoroquinolones can shorten the duration of diarrhea 4.
- Ciprofloxacin plus loperamide is not significantly better than ciprofloxacin alone in treating traveler's diarrhea, although loperamide may have some benefit in the first 24 hours of treatment 5.
Antibiotic Treatment
- Fluoroquinolones, azithromycin, and rifaximin are commonly used antibiotics for treating traveler's diarrhea 6.
- Azithromycin can be used to treat dysentery, while fluoroquinolones and rifaximin cannot 6.
- Ciprofloxacin is the standard treatment for self-therapy of traveler's diarrhea, except in South or Southeast Asia where azithromycin is preferred 7.
Prevention and Management
- Pretravel education on hygiene and safe food selection can help minimize episodes of traveler's diarrhea 6.
- For mild cases, bismuth subsalicylate or loperamide may be considered, while for moderate to severe cases, antibiotics like fluoroquinolones, azithromycin, or rifaximin may be used 6.
- Judicious use of antimotility agents and antimicrobial therapy can reduce the duration and severity of diarrhea 6.