Treatment of travelers'diarrhea

 The most common cause of travelers' diarrhea, usually a self-limited illness lasting several days, is infection with noninvasive enterotoxigenic (ETEC) or enteroag- gregative (EAEC) strains of  E. coli. Less common pathogens  include Shigella, Salmonella, Campylobacter, Aeromonas, viruses and parasites. For mild to moderate diarrhea, loperamide (Imodium, and others), an over-the-counter antiperistaltic agent, or bismuth subsalicylate (PeptoBismol,  and others) usually relieves symptoms in less than 24 hours. Packets of oral rehydration salts mixed in potable water can help maintain electroyte balance.

When diarrhea is severe or associated with fever or bloody stools, self- treatment with a 3-day course of ciprofloxacin, levofloxacin, norfloxacin, or ofloxacin is usually recommended. One- and two-day courses may also be effective.

Azithromycin  (Zithromax) is an alternative for travelers to areas with fluoroquinolone-resistant  Campylobacter, such as Thailand, and for pregnant women, children and those who do not respond to a fluoroquinolone within 48 hours.