Prophylaxis

Medical Letter consultants generally do not prescribe antibiotic prophylaxis for travelers' diarrhea, but rather instruct thec patient to begin self-treatment when symptoms are distressing or per- sistent. Some travelers, however, such as immunocompromised patients, might benefit from prophylaxis. In such patients, once-daily ciprofloxacin  (Cipro) 500 mg, levofloxacin  (Levaquin) 500 mg, ofloxacin  (Floxin) 300 mg or norfloxacin  (Noroxin) 400 mg can be given and are generally well tolerated. Bismuth subsalicylate (Pepto- Bismol, and others) can also prevent diarrhea in travelers who take 2 tablets 4 times/d, but it is less effective than antibiotics.