From the Guidelines
If loperamide doesn't work for diarrhea, azithromycin is a recommended alternative, given its strong recommendation and high level of evidence for treating moderate travelers’ diarrhea. When considering alternative medications, several options can be evaluated based on the cause and severity of the diarrhea.
- For moderate travelers’ diarrhea, fluoroquinolones may be used, although with caution due to the emergence of resistance and potential adverse effects 1.
- Azithromycin is a preferred choice due to its strong recommendation and high level of evidence, making it a suitable option for treating moderate travelers’ diarrhea 1.
- Rifaximin may also be considered, but with caution, especially in regions with a high risk of invasive pathogens 1. It's crucial to note that the choice of medication should be guided by the severity of symptoms, potential causes, and the patient's medical history.
- Staying hydrated with electrolyte solutions is essential while taking these medications.
- If diarrhea persists or is accompanied by severe symptoms, medical attention should be sought to rule out more serious conditions requiring different treatment.
From the Research
Alternative Medications for Diarrhea
If loperamide does not work for diarrhea, other medications can be considered.
- Bismuth subsalicylate is an alternative option, as seen in a study comparing loperamide with bismuth subsalicylate for the treatment of acute travelers' diarrhea 2.
- Trimethoprim-sulfamethoxazole can be used for subjects whose condition is not improved with loperamide therapy, as mentioned in a study on acute nondysenteric travelers' diarrhea 2.
- Antibiotics such as fluoroquinolones, azithromycin, and rifaximin may be used for moderate to severe travelers' diarrhea, with loperamide considered as monotherapy or adjunctive therapy 3.
Considerations for Treatment
When considering alternative medications, it is essential to note the following:
- Loperamide is effective for painless diarrhea and is considered to be free of abuse potential 4, 5.
- Bismuth subsalicylate is less effective than loperamide in reducing the average number of unformed bowel movements 6.
- Antibiotics should be used judiciously, as they may not be necessary for mild cases of travelers' diarrhea 3.