From the Guidelines
Azithromycin is not recommended for the prevention of traveler's diarrhea due to widespread bacterial resistance, as stated in the guidelines from 2001 1. The use of azithromycin for prevention of traveler's diarrhea is generally discouraged due to concerns about promoting antibiotic resistance and altering the gut microbiome.
- The guidelines from 2001 1 suggest that macrolides, including azithromycin, are no longer recommended for the treatment of traveler's diarrhea due to widespread bacterial resistance.
- Instead, travelers should focus on preventive measures such as careful food and water selection, hand hygiene, and carrying azithromycin for self-treatment if diarrhea occurs.
- The typical treatment dose of azithromycin for traveler's diarrhea is 1000 mg as a single dose or 500 mg daily for 3 days, but this should only be used for treatment, not prevention.
- Quinolones are currently the empirical antimicrobials of choice for dysentery or identified infectious diarrhea, and can be safely combined with loperamide to hasten remission 1.
- It's essential to note that antimicrobials have limitations, including drug interactions, skin reactions, and increasing bacterial resistance, and their use should be reserved for high-risk travelers or those with special circumstances.
From the Research
Travelers Diarrhea Prevention with Azithromycin
- Azithromycin is an antibiotic that can be used for the treatment of traveler's diarrhea, but its use as a preventive measure is not commonly recommended 2, 3.
- According to a study published in 2007, rifaximin is a more effective preventive strategy for traveler's diarrhea, especially in high-risk areas 2.
- Another study published in 2019 suggests that pretravel education on hygiene and safe food selection is important in minimizing episodes of traveler's diarrhea, and azithromycin can be used for the treatment of moderate to severe cases 4.
- A 2017 study states that antibiotic prophylaxis, including azithromycin, has been recommended only under special circumstances, such as for travelers with underlying illnesses who cannot tolerate diarrhea 3.
- A 2024 systematic review and network meta-analysis found that rifaximin and bismuth subsalicylate are more effective than other modalities, including probiotics and vaccines, in reducing the incidence of traveler's diarrhea, but does not mention azithromycin as a preventive measure 5.
Azithromycin for Treatment of Travelers Diarrhea
- Azithromycin is effective for the treatment of traveler's diarrhea, especially in areas where Campylobacter is common 4, 3.
- A 2007 study found that azithromycin and loperamide are comparable to levofloxacin and loperamide for the treatment of traveler's diarrhea in United States military personnel in Turkey 6.
- Azithromycin can be used for the treatment of dysentery, whereas fluoroquinolones and rifaximin cannot be used for this purpose 4.