From the Guidelines
For second-line treatment of traveler's diarrhea, azithromycin is the preferred antibiotic, typically given as a single 1000 mg dose or 500 mg daily for 3 days, due to its high efficacy and safety profile, as demonstrated in recent studies 1. When considering second-line treatment for traveler's diarrhea, it's essential to assess the severity of symptoms and the impact on the patient's activities. The choice of antibiotic should be based on factors such as the likelihood of treatment efficacy, regional patterns of probable target pathogens and their antimicrobial resistance, safety and tolerance profile of the antibiotic, and cost. Some key points to consider when selecting an antibiotic for second-line treatment of traveler's diarrhea 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
- Fluoroquinolones, such as ciprofloxacin and levofloxacin, may be used as alternative options, but their effectiveness is limited in many regions due to increasing resistance 1
- Rifaximin is another option for non-invasive diarrhea, but its efficacy is lower for invasive pathogens 1
- Loperamide may be used as adjunctive therapy to slow intestinal motility and provide symptom relief, and it can also be considered as monotherapy for moderate traveler's diarrhea 1 It's crucial to note that antibiotics should be used judiciously, taking into account the potential risks and benefits, and that patients should be advised to seek medical attention if symptoms worsen or if there are signs of complications, such as high fever, bloody stools, or severe abdominal pain. Adequate hydration remains essential during treatment.
From the Research
Second Line Treatment for Traveller's Diarrhea
- The treatment for traveller's diarrhea typically involves a combination of an antibiotic and loperamide, with the choice of antibiotic depending on the severity of the illness and the presence of any underlying medical conditions 2.
- For non-inflammatory diarrhea, azithromycin and loperamide have been shown to be comparable to levofloxacin and loperamide in terms of efficacy, with median time to last diarrheal stool and resolution of associated symptoms being similar between the two groups 2.
- However, azithromycin was associated with more nausea in the 30 minutes after dosing, although no vomiting or other adverse events were noted in either group 2.
- In cases where fluoroquinolones are not suitable, rifaximin may be a safer alternative, with mild interaction effects with metformin and no interaction effects with other antidiabetic drugs 3.
- For patients with chronic comorbidities, such as diabetes, hypertension, or cardiovascular disease, careful consideration of potential drug interactions is necessary when selecting an antibiotic for traveller's diarrhea 3.
- Other options for second line treatment include trimethoprim-sulfamethoxazole, which can reduce the duration of diarrhea to approximately 1 day, and bismuth subsalicylate, which can be used as an alternative to rifaximin for prevention 4, 5.
- Loperamide can be used in conjunction with an antibiotic to provide rapid symptomatic improvement, but should not be used as monotherapy for moderate to severe traveller's diarrhea 5, 6.