Travelers’ diarrhea

Agent Dosages Comments
Loperamide 4 mg initially, then 2 mg after each stool, not to exceed 8 mg/da Should not be used in patients with fever and dysentery
Bismuth subsalicylate 30 mL or 2 tablets (262 mg/tablet) PO q 30 min up to 8 doses/da Should not be used with doxycycline when used for malaria prophylaxis
Caution in people taking aspirin
Ciprofloxacin 500 mg PO BID or 750 mg PO qd for 1–3 d Treatment failures most common because of resistant strains of Campylobacter
Rifaximin 200 mg PO TID for 3 d Not recommended for febrile dysenteric diarrhea
Azithromycin 1000 mg single dose or 500 mg PO 1× and then 250 mg qd for 1 or 2 more d Treatment of choice for febrile dysentery when Campylobacter is known to be the causative agent

a To be used for no more than 48 h.

For febrile dysenteric diarrhea, a systemic antibiotic, including the fluoroquinolones (ciprofloxacin, levofloxacin) or azithromycin, is preferred. Fluoroquinolones should not be used in children and pregnant women because they have been shown to damage articular cartilage in growing animals. These agents may interfere with xanthine metabolism, so patients taking theophylline may need to adjust their dosage of the drug. Fluoroquinolone resistance has become a problem with Campylobacter strains seen worldwide, which is a limitation of ciprofloxacin or levofloxacin.

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Jun 18, 2016 | Posted by in INFECTIOUS DISEASE | Comments Off on Travelers’ diarrhea

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