MEDizzy - The patient described in the above question is no better

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Acute Complaints

The patient described in the above question is no better after 7 days and returns to your office for an evaluation. He reports that he has had up to 10 watery stools per day. He reports no appetite, and denies nausea, fever, or bloody stools. What is the best therapy to try at this time?

ExplanationTraveler’s diarrhea unresponsive to supportive care and loperamide after 7 days should be treated with antimicrobials. The treatment of choice is loperamide and a single dose of ciprofloxacin (750 mg). Levofloxacin (500 mg) or ofloxacin (200 mg) can also be used. Azithromycin (1000 mg) should be used if diarrhea is associated with bloody stools, or is persistent after a single dose of a fluoroquinolone. Rifaximin is a nonabsorbable agent that should be reserved for diarrhea found in travelers where invasive bacteria more commonly cause diarrhea or where fluoroquinolone-resistant campylobacter is prevalent (Indian subcontinent and Asia).