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Oral antibiotics for treatment of travelers' diarrhea

Oral antibiotics for treatment of travelers' diarrhea
Agent Adult dose Adult duration Pediatric dose Pediatric duration Comments
Azithromycin 1000 mg once Single dose* 20 mg/kg once (max dose 1000 mg) Single dose*
  • Preferred for dysentery or febrile diarrhea, travelers from Southeast Asia, and pregnant persons.
  • The 1000 mg single dose may be associated with nausea which may be reduced by administering as 2 divided doses on the same day.
500 mg once daily 3-day course 10 mg/kg/dose (max dose 500 mg) once daily 3-day course
Rifaximin 200 mg three times daily 3-day course

Age ≥12 years: 200 mg three times daily

Age <12 years: Not recommended

 3-day course
  • Minimally absorbed.
  • Not for use with dysentery or febrile diarrhea.
Rifamycin sodiumΔ Delayed-release tablets: 388 mg twice daily 3-day course Delayed-release tablets:
  • Age ≥12 years: 388 mg twice daily
  • Age <12 years: Not recommended
 3-day course
Levofloxacin 500 mg once daily Single dose* or 3-day course

Age 6 months to <5 years: 8 to 10 mg/kg (max dose 500 mg) twice daily

Age ≥5 years: 10 mg/kg/dose (max dose 500 mg) once daily

 3-day course
  • Fluoroquinolones are not preferred agents given their adverse event profile and increasing antimicrobial resistance.
  • Dose adjustment of 3-day regimen may be needed for patients with impaired kidney function.
Ciprofloxacin 750 mg once Single dose* 15 mg/kg per dose (max dose 500 mg) twice daily 3-day course
500 mg twice daily 3-day course
Ofloxacin 400 mg once daily Single dose* or 3-day course Pediatric dosing not established; may consider 7.5 mg/kg per dose (max dose 400 mg) twice daily 3-day course
For use in conjunction with UpToDate content on treatment of travelers' diarrhea.

* If symptoms have not resolved after 24 hours, the regimen can be extended to complete a 3-day course (using the dosing listed for the 3-day course).

¶ In children 3 to 11 years, limited data support use of rifaximin 100 mg orally four times daily for up to 5 days[1,2].

Δ Delayed-release rifamycin sodium tablets are no longer available in the United States but may be available in other areas. For some products (eg, Relafalk), strength is expressed as rifamycin sodium. Equivalence: 200 mg rifamycin sodium ≈194 mg rifamycin (base).

References:
  1. Beseghi U, De'Angelis GL. Comparison of two non-absorbable antibiotics for treatment of bacterial enteritis in children. Eur Rev Med Pharmacol Sci 1998; 2:131.
  2. Frisari L, Viggiano V, Pelagalli M. An open, controlled study of two non-absorbable antibiotics for the oral treatment of paediatric infectious diarrhea. Curr Med Res Opin 1997; 14:39.

Prepared with information from:

  • Riddle MS, Connor BA, Beeching NJ, et al. Guidelines for the prevention and treatment of travelers' diarrhea: a graded expert panel report. J Travel Med 2017; 24:S57.
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