Azithromycin: Use it for traveler’s diarrhea in South and Southeast Asia where Campylobacter is highly resistant to quinolones.
Ciprofloxacin: It is recommended for travel to South and Central America and to Africa.
Loperamide: May be used to as sole therapy for mild diarrhea or as adjunctive therapy for moderate or severe diarrhea.
Travelers’ diarrhea definitions (CDC)
Mild (acute): diarrhea that is tolerable, is not distressing, and does not interfere with planned activities.
Moderate (acute): diarrhea that is distressing or interferes with planned activities.
Severe (acute): diarrhea that is incapacitating or completely prevents planned activities; all dysentery is considered severe.
Travelers’ diarrhea treatment recommendations (CDC)
Therapy of mild travelers’ diarrhea
- Antibiotic treatment is not recommended in patients with mild travelers’ diarrhea.
- Loperamide or bismuth subsalicylate (BSS) may be considered in the treatment of mild travelers’ diarrhea.
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Therapy of moderate travelers’ diarrhea
- Antibiotics may be used to treat cases of moderate travelers’ diarrhea.
- Fluoroquinolones may be used to treat moderate travelers’ diarrhea.
- Azithromycin may be used to treat moderate travelers’ diarrhea.
- Rifaximin may be used to treat moderate travelers’ diarrhea.
- Loperamide may be used as adjunctive therapy for moderate to severe travelers’ diarrhea.
- Loperamide may be considered for use as monotherapy in moderate travelers’ diarrhea.
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Therapy of severe travelers’ diarrhea
- Antibiotics should be used to treat severe travelers’ diarrhea.
- Azithromycin is preferred to treat severe travelers’ diarrhea.
- Fluoroquinolones may be used to treat severe, nondysenteric travelers’ diarrhea.
- Rifaximin may be used to treat severe, nondysenteric travelers’ diarrhea.
- Single-dose antibiotic regimens may be used to treat travelers’ diarrhea.
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Reference
https://wwwnc.cdc.gov/travel/yellowbook/2018/the-pre-travel-consultation/travelers-diarrhea
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