Active substances: Ciprofloxacin
References Mild traveler's diarrhea can usually be managed with the judicious use of antimotility agents such as loperamide Imodium A-D, in a dosage of two 2-mg tablets initially, then one tablet after each loose stool maximum 24-hour dosage: 8 mg.
Additionally, a single dose of ciprofloxacin—750 mg; levofloxacin Levaquin —500 mg; or ofloxacin Floxin —400 mg, usually relieves mild cases of traveler's diarrhea in less than 24 hours.
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Always take antibiotics exactly the way your doctor advised. Even then, it should be used only in cases where treatment with a fluoroquinolone and an antimicrobial active against Giardia such as metronidazole or tinidazole has failed.
Fluoroquinolones such as ciprofloxacin, norfloxacin, ofloxacin, and levofloxacin have until recently been the drugs of choice for the empirical treatment of traveler's diarrhea in adults 31, 45.
Disadvantages of their use include drug interactions, such as those with warfarin and anticonvulsants, and the recent emergence of drug resistance, especially among Campylobacter isolates from Thailand 79.
In instances where the use of a fluoroquinolone is appropriate, a 3-day course is usually effective 34.
As a rule of thumb, if evidence of invasive disease exists, such as high fever, chills, or bloody diarrhea, a 3-day course of treatment should be taken. In areas where fluoroquinolone-resistant C.
Single-dose azithromycin 1,000 mg has also been shown to be equivalent to single-dose ciprofloxacin 500 mg for the treatment of traveler's diarrhea in adults visiting Mexico, although microbial eradication rates were nonsignificantly lower with azithromycin than with ciprofloxacin 1.
The treatment of traveler's diarrhea in children under the age of 2 years is usually recommended to be oral rehydration alone.
The drug rifaximin has recently been shown to be an effective chemotherapeutic agent for traveler's diarrhea. Four major studies assessing the efficacy of rifaximin in the treatment of traveler's diarrhea have been conducted in Mexico, Guatemala, Kenya, and Jamaica 35, 41, 88, 153.
However, these studies have been conducted primarily with individuals without dysentery, so treatment with rifaximin should be limited to those without fever, bloody stool, or systemic toxicity. Mild diarrhea up to three loose bowel movements a day can be self-treated with oral rehydration and loperamide.
If symptoms worsen or do not improve after 24 h, treatment with an antibiotic should be initiated. Traveler's diarrhea that is associated with more severe symptoms warrants immediate treatment with both loperamide and an antibiotic.
Until recently, the preferred antibiotic class for self-treatment of traveler's diarrhea has been the fluoroquinolones, although the exact choice should be decided by a host of factors, such as the traveler's itinerary, age, pregnancy status, and drug allergies; potential drug interactions; and whether or not chemoprophylaxis against traveler's diarrhea or malaria will also be taken.
Before beginning antibiotic therapy, however, patients should first take a dose of loperamide to see if the antimotility agent stops the diarrhea.
Antibiotic therapy should be deferred until it is clear that the diarrheal illness requires antibiotic therapy, since dietary change and stress can cause transient gastrointestinal upset.
Ciprofloxacin is not recommended in patients with seizure disorders, in patients who are pregnant and in children under 18 years of age. Children older than two years of age can be given trimethoprim-sulfamethoxazole.
Travellers' diarrhea generally falls into two main groups: presumed bacterial and presumed protozoal Giardia. Amoebic dysentery is rare in trekkers; Cyclospora "blue-green algae" is only seen during the monsoon summer months, and thus rarely in trekkers; there are no specific treatments for the viruses.
Enterotoxigenic Escherichia coli is the chief cause, followed by Shigella.
In general, bacterial diarrhea is characterized by a sudden onset of "explosive" watery diarrhea, plus or minus any of: fever, nausea, or blood in the stool. The onset is from one to seven days after exposure, and is usually so dramatic that patients can tell us just when they got sick.
I can recall no better description of this syndrome than that given by B.