Traveler's diarrhea medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

TD usually is a self-limited disorder and often resolves without specific treatment; however, oral rehydration therapy is often beneficial to replace lost fluids and electrolytes. Antibiotics are used in those who develop three or more loose stools in a 24-hour period — especially if associated with nausea, vomiting, abdominal cramps, fever or blood in stools

Medical Therapy

Rehydration Therapy

TD usually is a self-limited disorder and often resolves without specific treatment; however, oral rehydration therapy is often beneficial to replace lost fluids and electrolytes. Clear liquids are routinely recommended for adults. Water that is purified is best, along with oral rehydration salts to replenish lost electrolytes. Carbonated water (soda), which has been left out so that the carbonation fizz is gone, is quite useful. There can be 100% recovery from cholera when properly treated, which usually only means rehydration, usually through an intravenous line.

Antimicrobial Therapy

Travelers who develop three or more loose stools in a 24-hour period — especially if associated with nausea, vomiting, abdominal cramps, fever, or blood in stools — should be treated by a doctor and may benefit from antimicrobial therapy. Antibiotics usually are given for 3–5 days, but single dose azithromycin or levofloxacin have been used. If diarrhea persists despite therapy, travelers should be evaluated and treated for possible parasitic infection. There are different medications needed for bacterial dysentery, for amoebic dysentery, for giardia and for worms. There is no medication for Cryptosporidium, which can devastate people with AIDS.

Preferred treatment regimen

• 4. Traveler’s diarrhea

• 4.1 Prophylaxis

• Preferred regimen (1): Bismuth subsalicylate two chewable tablets qid
• Preferred regimen (2): Norfloxacin 400 mg PO qd
• Preferred regimen (3): Ciprofloxacin 500 mg PO qd
• Preferred regimen (4): Rifaximin 200 mg PO qd or bid

• 4.2 Symptomatic treatment

• Preferred regimen (1): Bismuth subsalicylate 1 oz PO every 30 min for 8 doses
• Preferred regimen (2): Loperamide 4 mg PO THEN 2 mg after each loose stool not to exceed 16 mg daily

• 4.3 Antibiotic treatment

• Preferred regimen (1): Norfloxacin 400 mg PO bid
• Preferred regimen (2): Ciprofloxacin 500 mg PO bid
• Preferred regimen (3): Ofloxacin 200 mg PO bid
• Preferred regimen (4): Levofloxacin 500 mg PO qd
• Preferred regimen (5): Azithromycin 1000 mg PO single dose
• Preferred regimen (6): Rifaximin 200 mg PO tid

Antimotility Agents

Antimotility agents (loperamide, diphenoxylate, and paregoric) primarily reduce diarrhea by slowing transit time in the gut, and, thus, allows more time for absorption. Some persons believe diarrhea is the body's defense mechanism to minimize contact time between gut pathogens and intestinal mucosa. In several studies, antimotility agents have been useful in treating travelers' diarrhea by decreasing the duration of diarrhea. However, these agents should never be used by persons with fever or bloody diarrhea, because they can increase the severity of disease by delaying clearance of causative organisms. Because antimotility agents are now available over the counter, their injudicious use is of concern. Adverse complications (toxic megacolon, sepsis, and disseminated intravascular coagulation) have been reported as a result of using these medications to treat diarrhea.