Treatment of diarrhea

Loperamide (Imodium, and others), an over-the-counter synthetic opioid (4-mg loading dose, then 2 mg orally after each loose stool to a maximum of 16 mg/d for adults), usually relieves symptoms of travelers' diarrhea in <24 hours. Loperamide is approved for use in children >2 years old.

If diarrhea is severe or associated with fever or bloody stools, self-treatment with a 3-day course of ciprofloxacin 500 mg b.i.d., levofloxacin 500mg once daily, norfloxacin 400 mg b.i.d. or ofloxacin 300 mg b.i.d. is recommended. One- and two-day courses may also be effective. Azithromycin (Zithromax) (1000 mg as a single dose or 500 mg/d x 3d) is an alternative (JA Adachi et al, Clin Infect Dis 2003; 37:1165) and is the drug of choice for travelers to areas with ahigh prevalence of fluoroquinolone-resistant  Campylobacter, such as Thailand. It can also be used in other select groups, including pregnant women, children (10 mg/kg/d x 3d), and  patients who do not respond to a fluoroquinolone in 48 hours.

[Rifaximin (Xifaxan), a non-absorbed oral antibiotic indicated for treatment of travelers' diarrhea caused by noninvasive strains of E. coli., was approved by the FDA after publication of this article. The Medical Letter has reviewed rifaximin (Xifaxan). Packets of oral rehydration salts mixed in potable water can help maintain electrolyte balance, particularly in children and the elderly. They are available from suppliers of travel-related products and in some pharmacies in the US, and from pharmacies overseas.