From the Guidelines
For the treatment of travelers' diarrhea, azithromycin is recommended as a single 1-gm dose or 500 mg daily for 3 days, due to its efficacy and safety profile, as well as the increasing resistance of Campylobacter spp. to fluoroquinolones 1. When considering the treatment of travelers' diarrhea, it is essential to assess the severity of the illness and its impact on the traveler's activities.
- The decision to treat with azithromycin should be based on the presence of moderate to severe symptoms, such as fever, bloody stools, or significant dehydration.
- Azithromycin has been shown to be effective against a range of bacterial causes of travelers' diarrhea, including Campylobacter, E. coli, and Shigella 1.
- The single-dose regimen of azithromycin is often preferred for convenience while traveling, but a 3-day course of 500 mg daily may also be used 1.
- It is crucial to note that azithromycin is generally well-tolerated, with minimal side effects, usually dose-related gastrointestinal complaints 1.
- While taking azithromycin, it is essential to stay hydrated with clean water or oral rehydration solutions to prevent dehydration and support the recovery process.
- Azithromycin should be avoided in patients with a history of QT interval prolongation or liver disease, and caution should be exercised when using it in patients with a history of gastrointestinal disorders 1.
From the Research
Azithromycin Dose for Traveler's Diarrhea
- The recommended dose of azithromycin for traveler's diarrhea is 1000 mg as a single dose, as studied in 2 and 3.
- However, a lower dose of 500 mg may also be effective, as shown in 4, where a single 500 mg dose of azithromycin appeared as effective as a 1000 mg dose.
- Azithromycin is often used in combination with loperamide, which has been shown to be more effective than azithromycin alone in treating traveler's diarrhea, as demonstrated in 2 and 4.
- The use of azithromycin is preferred over ciprofloxacin in certain regions, such as South or Southeast Asia, due to increased drug resistance among enteropathogens, as mentioned in 5.
Efficacy and Safety
- Azithromycin has been found to be comparable to levofloxacin in the treatment of traveler's diarrhea, with similar median times to last unformed stool and numbers of unformed stools passed, as shown in 2 and 3.
- The combination of azithromycin and loperamide has been shown to be more effective than azithromycin alone, with a shorter duration of diarrhea and fewer unformed stools passed, as demonstrated in 4.
- Azithromycin is generally well-tolerated, with possible minor, self-limiting adverse events, such as nausea, as reported in 2 and 3.