Is Hidrasec (electrolyte replacement) effective for treating traveller's diarrhea?

Hidrasec for Traveller's Diarrhea

Critical Clarification

Hidrasec (racecadotril) is NOT mentioned in any current international guidelines for traveller's diarrhea treatment, and the evidence overwhelmingly supports azithromycin as first-line antibiotic therapy combined with loperamide for symptomatic relief—not racecadotril or other antisecretory agents. 1

Evidence-Based Treatment Algorithm

Mild Traveller's Diarrhea

• Loperamide is the preferred treatment: 4 mg loading dose, then 2 mg after each loose stool, maximum 16 mg per day 1
• Ensure adequate hydration with oral rehydration solutions 1
• No antibiotics are recommended for mild cases 1

Moderate Traveller's Diarrhea

• Azithromycin is the preferred antibiotic: either single 1-gram dose OR 500 mg daily for 3 days 1, 2
• Loperamide can be used as monotherapy OR combined with antibiotics for faster relief, reducing illness duration from 59 hours to approximately 1 hour 1
• When combining loperamide with antibiotics, mean time to last unformed stool decreases to less than half a day 1

Severe Traveller's Diarrhea or Dysentery

• Azithromycin is mandatory: 1-gram single dose or 500 mg daily for 3 days 1, 2
• Loperamide can be used as adjunctive therapy ONLY if no fever or bloody stools are present 1
• Single-dose antibiotic regimens are preferred for better compliance 1

Regional Considerations

Southeast Asia and India

• Azithromycin is clearly superior and mandatory as first-line therapy due to fluoroquinolone resistance exceeding 85-90% for Campylobacter 1, 3
• This applies regardless of severity 1

Mexico

• Azithromycin remains the preferred agent 2
• Combination therapy (antibiotic plus loperamide) reduces illness duration from 59 hours to approximately 1 hour 1

Critical Safety Warnings

• Discontinue loperamide immediately if fever, severe abdominal pain, or blood in stool appears 1
• Avoid loperamide beyond 48 hours if symptoms persist 1
• Loperamide should NOT be used with dysentery or febrile diarrhea 1

When to Seek Medical Attention

• Symptoms do not improve within 24-48 hours despite self-treatment 1
• Bloody diarrhea develops 1
• High fever with shaking chills occurs 1
• Severe dehydration is present 1
• Microbiological testing is recommended for severe or persistent symptoms (>14 days) or treatment failures 1, 2

Why NOT Routine Antibiotic Prophylaxis

• Antimicrobial prophylaxis is strongly discouraged due to promotion of multidrug-resistant bacteria acquisition, adverse effects including potential for C. difficile infection, and disruption of gut microbiome 1
• Prophylaxis should be considered ONLY for travelers at high risk: severe immunosuppression, inflammatory bowel disease, or those who cannot tolerate any illness due to critical trip activities 1
• If prophylaxis is indicated, rifaximin is the recommended agent (200 mg three times daily), NOT fluoroquinolones 1

Practical Travel Kit Recommendations

• Pack azithromycin (prescription required) 1
• Pack loperamide for immediate use 1
• Pack oral rehydration salt packets 1
• Pack a thermometer 1

Common Pitfall to Avoid

Rifaximin should NOT be used for dysentery or febrile diarrhea, as it has documented treatment failures in up to 50% of cases with invasive pathogens 1. Rifaximin is only appropriate for non-invasive watery diarrhea 1.