Treatment and Monitoring

The goal of treatment is to maintain hydration and functional status to prevent disruption of travel plans. For travelers with mild cases of diarrhea, ORT is often all that is needed. However, antibiotics are effective at reducing the duration of illness. The use of trimethoprim-sulfamethoxazole has fallen out of favor because of the development of resistance in many regions. In general, fluoroquinolones, specifically levofloxacin (500 mg once daily for adults) and ciprofloxacin (500 mg twice daily for adults), are the drugs of choice for traveler's diarrhea. A 24-hour regimen can be used unless the

traveler has a fever or bloody stools, in which case a 3-day regimen is necessary. Alternatives to fluoroquinolones should be used in Asia, where resistance is high among Campylobacter. Azithromycin, as a single adult dose of 1,000 mg, represents an alternative to the fluoroquinolone class.2 The recommended regimen for children is azithromycin 5 to 10 mg/kg orally as a single dose. Additionally, the FDA recently approved rifaximin for the treatment of traveler's diarrhea at an adult dose of 200 mg three times daily for 3 days; rifaximin is not indicated for use in children under the age of 12 years. Rifaximin is not effective against C. jejuni, and efficacy has not been documented against Salmonella.

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