gastrointestinal disorders
Traveler’s Diarrhea
Treatment of Traveler's Diarrhea
Fluid replacement Sometimes antidiarrheal (antimotility) medications Antibiotics (eg,ciprofloxacin,azithromycin) for moderate to severe diarrhea The mainstay of treatment of traveler's diarrhea is fluid replacement and an antidiarrheal medication such asloperamide. The dosage ofloperamidefor children < 12 years of age is weight-based. An alternative for adults isdiphenoxylate/atropine. Antidiarrheal medications should not be used in adults with suspectedC. difficileorE. coliO157:H7 infection (eg, with recent antibiotic use, bloody diarrhea, heme-positive stool, or diarrhea with fever) or in children, particularly those<2 years. Iodochlorhydroxyquin, which may be available in some low- and middle-income countries, should not be used because it may cause neurologic damage. Antidiarrheal medications are contraindicated in patients with fever or bloody stools and in children < 2 years of age. Generally, antibiotics are not necessary for mild diarrhea. However, in patients with moderate to severe diarrhea (≥3 loose stools over 8 hours), antibiotics are given, especially if vomiting, abdominal cramps, fever, or bloody stools are present. For adults, recommended oral antibiotics includeciprofloxacin500 mg 2 times a day for 3 days orlevofloxacin500 mg once a day for 3 days, although fluoroquinolone resistance appears to be increasing in some areas, particularly inCampylobacter. Alternatives includeazithromycin500 mg once a day for 3 days orrifaximin200 mg 3 times a day for 3 days. For children,azithromycin5 to 10 mg/kg once a day for 3 days is preferred. (See also an expert panel's2017 guidelines for the prevention and treatment of travelers' diarrhea.) 