Dawaa Reference

infectious

Traveller's Diarrhoea

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources5 sources

CDC Yellow Book 2026: Travelers' Diarrhea (NCBI Bookshelf NBK620898), Treatment - Antibiotics; Table 1.6.1 · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (loperamide monograph) · WHO. The treatment of diarrhoea: a manual for physicians and other senior health workers, 4th rev. Geneva: WHO; 2005 · WHO/UNICEF reduced-osmolarity oral rehydration salts (245 mOsm/L), recommended since 2002 · Rifaximin (XIFAXAN) DailyMed label, SetID f73acb74-e930-4414-81e9-d2a01db36e30, section 2.1

Verified against4 documents
  • CDC Yellow Book 2026: Travelers' Diarrhea (NCBI Bookshelf NBK620898), Treatment - Antibiotics; Table 1.6.1
  • Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (loperamide monograph)
  • WHO. The treatment of diarrhoea: a manual for physicians and other senior health workers, 4th rev. Geneva: WHO; 2005
  • Traveller's Diarrhoea - disease-level clinical article (travellers-diarrhoea-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (4)

  • Toxin-driven diarrhea such as cholera or ETEC starts abruptly within hours of exposure, with profuse watery stools and little inflammation [diarrhoea]
  • Bacterial and viral causes usually appear 6 to 96 hours after exposure with sudden diarrhea that can include fever, vomiting, and blood [diarrhoea · fever · vomiting]
  • Protozoal infection has a longer 1-2 week incubation and comes on gradually with persistent mild symptoms and bloating [abdominal distension]
  • Untreated protozoal symptoms can drag on for weeks to months

Tests (5)

  • Routine lab testing usually isn't needed for travelers' diarrhea
  • High fever, bloody stools, or tenesmus should prompt lab workup including stool culture, fecal leukocytes, and lactoferrin
  • Stool culture identifies Campylobacter, Salmonella, and Shigella directly, while E coli and Vibrio need specialized culture methods
  • Imaging isn't routinely needed, but ultrasound may be used in severe, high-risk, or diagnostically uncertain cases
  • CT shows colitis, bowel wall thickening, and complications like perforation or abscess better than ultrasound

If not this — what else fits (5)

  • Post-infectious irritable bowel syndrome is the most common lingering non-infectious cause, affecting 10-15% of cases
  • Symptoms persisting past 14 days, or becoming chronic beyond 4 weeks, point away from infection toward a noninfectious cause
  • Postinfectious functional diarrhea is on the differential
  • Lactase deficiency or carbohydrate malabsorption is on the differential
  • Medications such as PPIs, magnesium antacids, antimalarial prophylaxis, metformin, or colchicine can cause diarrhea mimicking this

SourceStatPearls "Travelers' Diarrhea" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Non-absorbed oral antibiotic for moderate watery travellers' diarrhoea | Antimotility | Rehydration

MAIN TREATMENT - choose one

1

AZITHROMYCIN

1st line

Strength500 mg

Formoral.solid

Adult dose and duration

1000 mg single dose OR 500 mg once daily for 3 days x 1-3 days

Paediatric dose

10 mg/kg/dose [child max 500 mg]

(10 mg/kg once daily for 3 days (or 20 mg/kg single dose))

Dose by weight
3kg30 mg/dose
4kg40 mg/dose
5kg50 mg/dose
6kg60 mg/dose
7kg70 mg/dose
8kg80 mg/dose
9kg90 mg/dose
10kg100 mg/dose
11kg110 mg/dose
12kg120 mg/dose
13kg130 mg/dose
14kg140 mg/dose
15kg150 mg/dose
16kg160 mg/dose
17kg170 mg/dose
18kg180 mg/dose
19kg190 mg/dose
20kg200 mg/dose
21kg210 mg/dose
22kg220 mg/dose
23kg230 mg/dose
24kg240 mg/dose
25kg250 mg/dose
26kg260 mg/dose
27kg270 mg/dose
28kg280 mg/dose
29kg290 mg/dose
30kg300 mg/dose
31kg310 mg/dose
32kg320 mg/dose
33kg330 mg/dose
34kg340 mg/dose
35kg350 mg/dose
36kg360 mg/dose
37kg370 mg/dose
38kg380 mg/dose
39kg390 mg/dose
40kg400 mg/dose
41kg410 mg/dose
42kg420 mg/dose
43kg430 mg/dose
44kg440 mg/dose
45kg450 mg/dose
46kg460 mg/dose
47kg470 mg/dose
48kg480 mg/dose
49kg490 mg/dose
50kg500 mg/dose
AWaRe

WATCH group - carries resistance cost. Egyptian EML 2025.

Dose source

CDC Yellow Book 2026: Travelers' Diarrhea (NCBI Bookshelf NBK620898), Treatment - Antibiotics; Table 1.6.1

Why

Azithromycin is first-line in Egypt and South Asia due to widespread Campylobacter and ETEC fluoroquinolone resistance

Cautions
  • Azithromycin is first-line for severe travellers diarrhoea or dysentery (fever/bloody stools).
  • Fluoroquinolones (ciprofloxacin) are demoted in Egypt due to high resistance.
  • Take with plenty of fluids.
Egyptian brands
Egyptian brandManufacturerIndicative price
AZATRIBACT 500MG 3 CAPS.RIVA PHARMA S.A.E.13.50 EGP (4.50/unit)
GIGAZOCIN 500MG 5 CAPS.EGPI > PIONEER27.50 EGP (5.50/unit)
SYSTYMYCIN 500MG 3 CAPS.EGPI > NOVELL PHARMA21.50 EGP (7.17/unit)
AZITHROMASH 500 MG 3 F.C. TABS.MASH PREMIERE48.00 EGP (16.00/unit)
AZALIDE 500MG 3 CAPS.UP PHARMA52.00 EGP (17.33/unit)
AZROLID 500 MG 6 F.C.TABS.AMRIYA126.00 EGP (21.00/unit)
ZERAMERATE 500 MGEGPI > GAMMA PHARMA28.50 EGP
DISTABCIN 500 MG 3 DISPERSIBLE TABS.EGPI43.50 EGP
ZITHRODOSE 100MG/5ML SUSP. 15ML? strength differs? different route - not oral solidEL-OBOUR > AVERROES PHARMA-EGYPT12.00 EGP
ZITHROPHATE 200MG/5ML SUSP. 15ML? strength differs? different route - not oral solidORGANO PHARMA > NOVELL PHARMA12.75 EGP
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Traveller's Diarrhoea - disease-level clinical article (travellers-diarrhoea-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - Avoid antimotility agents in patients with fever or bloody diarrhea.

NON-ABSORBED ORAL ANTIBIOTIC FOR MODERATE WATERY TRAVELLERS' DIARRHOEA

3

RIFAXIMIN

Non-absorbed oral antibiotic for moderate watery travellers' diarrhoea

1st line

Strength200 mg

Formoral.solid

Adult dose and duration

One 200 mg tablet by mouth three times a day for 3 days, with or without food x 3 days

Paediatric dose

Not established below 12 years of age for travellers' diarrhoea; use the paediatric options listed instead.

Dose source

Rifaximin (XIFAXAN) DailyMed label, SetID f73acb74-e930-4414-81e9-d2a01db36e30, section 2.1 - verbatim: "The recommended dose of XIFAXAN is one 200 mg tablet taken orally three times a day for 3 days."

Why

The card already carries azithromycin, which is the right choice for severe or dysenteric illness. Rifaximin is the alternative for the common moderate, watery, non-febrile case: it stays in the gut, so it spares the patient systemic antibiotic exposure. It is registered in Egypt for exactly this indication and is affordable.

Cautions
  • It is the wrong drug when there is fever or blood in the stool: the label states it was not effective in that setting, so treat those patients as invasive disease and use azithromycin.
  • Stop it and reconsider the diagnosis if the diarrhoea worsens or has not improved within a day or two of starting.
  • It does not work against Campylobacter, and its effect against Shigella and Salmonella is unproven - the pathogens to suspect after travel in Asia.
  • Do not give it to anyone with a known hypersensitivity to rifaximin or to any rifamycin antibiotic.
  • Avoid it in pregnancy: teratogenic effects were seen in animal studies and there are no human data.
  • Rehydration remains the treatment; the antibiotic only shortens the illness.
Egyptian brands
Egyptian brandManufacturerIndicative price
IDIBACT 200 MG 10 F.C.TAB.INTERNATIONAL DRUG INDUSTRIES > NOVELL PHARMA34.00 EGP (3.40/unit)
TRENCEDIA 200 MG 30 F.C. TABS.MARCYRL PHARMACEUTICAL INDUSTRIES (MPI)130.50 EGP (4.35/unit)
BIOFAXIMIN 200 MG 30 F.C. TAB.BIOPHARM EGYPT > SAJA PHARMACEUTICALS188.00 EGP (6.27/unit)
TRAVERIA 200 MG 10 F.C. TAB.WESTERN PHARMACEUTICALS INDUSTRIES63.00 EGP (6.30/unit)
FATROXIM 200 MG 30 F.C. TAB.EGPI > ATM PHARMACEUTICAL INDUSTRIES243.00 EGP (8.10/unit)
TRAVIGUARD 200 MG 20 F.C. TABS.DBK PHARMA > TREND PHARM162.00 EGP (8.10/unit)
NORMIX 200 MG 12 F.C.TAB.ALFASIGMA > UNITED COMPANY FOR DISTRIBUTION134.50 EGP (11.21/unit)
GASTROBIOTIC 200 MG 20 F.C.TAB.ANDALOUS PHARMA243.00 EGP (12.15/unit)

ANTIMOTILITY - give alongside

4

LOPERAMIDE

Antimotility

add-on - not a substitute

Strength2 mg

Formoral.solid

Adult dose and duration

4 mg initially, then 2 mg after each loose stool, max 16 mg daily - Max 2 days

Paediatric dose

The Egyptian National Drug Formulary - Gastrointestinal Tract 2025 loperamide monograph contraindicates it in any child under 2 years, and confines its own indication to adults and to children of 12 years and above with acute diarrhoea. No dose below 12 years is stated there.

Dose source

Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (loperamide monograph)

Why

Adjunct antimotility agent added to rehydration therapy that slows gut transit via opioid-receptor activity in the intestinal wall, reducing stool frequency; it does not treat the underlying infection and is avoided when there is bloody or febrile dysentery.

Cautions
  • CONTRAINDICATED in dysentery (bloody stools/high fever) and bacterial colitis — risk of toxic megacolon.
  • Do not use for more than 48 hours.
Egyptian brands
Egyptian brandManufacturerIndicative price
MOTIJUST 2 MG 30 CAPSINTERNATIONAL DRUG INDUSTRIES > NOVELL PHARMA27.00 EGP (0.90/unit)
STOPRRHEA 2 MG 10 ORODISPERSIBLE TABS.WESTERN PHARMACEUTICALS INDUSTRIES > WESTERN PHARMA10.00 EGP
IMODIUM INSTANT 2MG 6 ORODISPERSIBLE TABS.MCNEIL PRODUCTS LTD. > JOHNSON & JOHNSON SCIENTIFIC OFFICE80.00 EGP
STOPRRHEA 2 MG 30 ORODISPERSIBLE TABS.WESTERN PHARMACEUTICALS INDUSTRIES > WESTERN PHARMA96.00 EGP

REHYDRATION - give alongside

5

ORS

Rehydration

add-on - not a substitute

Formoral.liquid

Adult dose and duration

Drink fluid/ORS solution after each loose stool - As needed

Paediatric dose

Encourage fluid replacement after every stool

Dose source

WHO. The treatment of diarrhoea: a manual for physicians and other senior health workers, 4th rev. Geneva: WHO; 2005

Why

Adjunct oral rehydration solution added alongside antimicrobial and antimotility therapy to replace the fluid and electrolyte losses of traveller's diarrhoea; it does not treat the underlying infection but is essential supportive care regardless of cause.

Cautions
  • Use the reduced-osmolarity formulation (sodium 75, glucose 75, potassium 20, citrate 10, chloride 65 mmol/L; 245 mOsm/L). WHO replaced the older 311 mOsm/L formula in 2002 for diarrhoea of any cause at any age - it cuts stool output and vomiting.
  • ORS is essential baseline therapy to prevent dehydration.
Egyptian brands
Egyptian brandManufacturerIndicative price
GLUCOHYDRAN 10 SACHET.ARAB DRUG COMPANY (ADCO)1.75 EGP
REHYDRAN N 10 SACHETCID4.50 EGP
REHYDRO ZINC 10 SACHETSCID7.00 EGP
ORS 20 SACHETSPHAROPHARMA40.00 EGP
ELECTRO MASH SYRUP 200 MLMASH PREMIERE60.00 EGP
FLEXOLYTE ORAL REHYDRATION SOL. 240 MLKEMPETRO FOR CHEMICAL INDUSTRIES65.00 EGP
HERO ORS 200 MLHERO > HERO MEA TRADING120.00 EGP
SANSO ORS SYRUP 140 MLAUG PHARMA400.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.