Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Diarrhoea - prevention and advice for travellers - Management
How should I prescribe antibiotics for prophylaxis or empirical treatment of traveller's diarrhoea?

  • For the prophylaxis of traveller's diarrhoea:
    • Prescribe ciprofloxacin 500 mg once daily (off-label use, requiring private prescription) for up to 3 weeks.
    • Do not prescribe ciprofloxacin for the following groups; seek specialist advice:
      • Children and adolescents.
      • Women who are pregnant or breastfeeding.
      • People travelling to countries where quinolone resistance is prevalent (for example Thailand and the Far East).
      • People for whom quinolones are not suitable or contraindicated.
    • Azithromycin is not suitable for prophylaxis.
  • For the empirical treatment of traveller's diarrhoea (to be taken if needed):
    • Prescribe ciprofloxacin 500 mg twice daily for 3 days (licensed indication, requiring private prescription).
      • Advise the person to evaluate response after 24 hours of taking antibiotic (see advice below).
    • Prescribe azithromycin (off-label use, requiring private prescription) instead of ciprofloxacin for the following groups:
      • Children and adolescents.
      • People travelling to countries where quinolone resistance is prevalent (for example Thailand and the Far East).
      • Pregnant women.
      • People for whom quinolones are contraindicated.
    • For adults and children of more than 45 kg body weight, prescribe azithromycin 500 mg daily for 3 days (off-label use).
    • For children 6 months of age or more who weigh less than 45 kg, prescribe azithromycin 10 mg/kg once daily (maximum dose 500 mg once daily) for 3 days (off-label use). As a guide:
      • Body weight 15–25 kg (approximately 3–7 years of age): 200 mg once daily for 3 days.
      • Body weight 26–35 kg (8–11 years of age): 300 mg once daily for 3 days.
      • Body weight 36–45 kg (12–14 years of age): 400 mg once daily for 3 days.
      • Body weight greater than 45 kg: dose as for adults.
      • Remind the parent or carer that azithromycin 200 mg/5 mL suspension must be reconstituted using safe drinking water.
    • Advise on the appropriate use of empirical antibiotics:
      • Antibiotics should be taken only when symptoms are moderate-to-severe (for example bowel movements becoming very frequent, very watery, or containing blood) or if symptoms last beyond 3 days.
      • The person should assess their response to treatment after 24 hours — if they are still unwell they should complete the 3-day course, but if they are much improved there is no need to continue treatment.
      • The addition of loperamide (off-label use) can be considered if immediate control of symptoms is required, but loperamide must be avoided if the person is feverish or has bloody diarrhoea. The combination should not be used for more than 2 days.

© NHS Institute for Innovation and Improvement