# Traveller's Diarrhoea - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - 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 date: 2026-08 ## Verified against - 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) ## Treatment metadata - Azithromycin — 500 mg — oral.solid - Referral & safety-netting (no drug therapy) - Rifaximin — 200 mg — oral.solid - Loperamide — 2 mg — oral.solid - ORS — oral.liquid ## Complete treatment card ```text TRAVELLER'S DIARRHOEA 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 Review status: REVIEWED against 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) (2026-08) 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 Source StatPearls "Travelers' Diarrhea" - disease-level clinical article Status 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] Adult 1000 mg single dose OR 500 mg once daily for 3 days x 1-3 days Peds 10 mg/kg/dose [child max 500 mg] (10 mg/kg once daily for 3 days (or 20 mg/kg single dose)) 3kg -> 30 mg/dose 4kg -> 40 mg/dose 5kg -> 50 mg/dose 6kg -> 60 mg/dose 7kg -> 70 mg/dose 8kg -> 80 mg/dose 9kg -> 90 mg/dose 10kg -> 100 mg/dose 11kg -> 110 mg/dose 12kg -> 120 mg/dose 13kg -> 130 mg/dose 14kg -> 140 mg/dose 15kg -> 150 mg/dose 16kg -> 160 mg/dose 17kg -> 170 mg/dose 18kg -> 180 mg/dose 19kg -> 190 mg/dose 20kg -> 200 mg/dose 21kg -> 210 mg/dose 22kg -> 220 mg/dose 23kg -> 230 mg/dose 24kg -> 240 mg/dose 25kg -> 250 mg/dose 26kg -> 260 mg/dose 27kg -> 270 mg/dose 28kg -> 280 mg/dose 29kg -> 290 mg/dose 30kg -> 300 mg/dose 31kg -> 310 mg/dose 32kg -> 320 mg/dose 33kg -> 330 mg/dose 34kg -> 340 mg/dose 35kg -> 350 mg/dose 36kg -> 360 mg/dose 37kg -> 370 mg/dose 38kg -> 380 mg/dose 39kg -> 390 mg/dose 40kg -> 400 mg/dose 41kg -> 410 mg/dose 42kg -> 420 mg/dose 43kg -> 430 mg/dose 44kg -> 440 mg/dose 45kg -> 450 mg/dose 46kg -> 460 mg/dose 47kg -> 470 mg/dose 48kg -> 480 mg/dose 49kg -> 490 mg/dose 50kg -> 500 mg/dose AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. 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 Caution 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. Egypt AZATRIBACT 500MG 3 CAPS. RIVA PHARMA S... 13.50 EGP (4.50/unit) GIGAZOCIN 500MG 5 CAPS. EGPI > PIONEER 27.50 EGP (5.50/unit) SYSTYMYCIN 500MG 3 CAPS. EGPI > NOVELL... 21.50 EGP (7.17/unit) AZITHROMASH 500 MG 3 F.C. TABS. MASH PREMIERE 48.00 EGP (16.00/unit) AZALIDE 500MG 3 CAPS. UP PHARMA 52.00 EGP (17.33/unit) AZROLID 500 MG 6 F.C.TABS. AMRIYA 126.00 EGP (21.00/unit) ZERAMERATE 500 MG EGPI > GAMMA ... 28.50 EGP DISTABCIN 500 MG 3 DISPERSIBLE TABS. EGPI 43.50 EGP ZITHRODOSE 100MG/5ML SUSP. 15ML EL-OBOUR > AV... 12.00 EGP -> ? strength differs, ? different route - not oral solid ZITHROPHATE 200MG/5ML SUSP. 15ML ORGANO PHARMA... 12.75 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult 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. Caution RED FLAG - Avoid antimotility agents in patients with fever or bloody diarrhea. NON-ABSORBED ORAL ANTIBIOTIC FOR MODERATE WATERY TRAVELLERS' DIARRHOEA 3. RIFAXIMIN [1st line] Adult One 200 mg tablet by mouth three times a day for 3 days, with or without food x 3 days Peds Not established below 12 years of age for travellers' diarrhoea; use the paediatric options listed instead. 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. Caution 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. Egypt IDIBACT 200 MG 10 F.C.TAB. INTERNATIONAL... 34.00 EGP (3.40/unit) TRENCEDIA 200 MG 30 F.C. TABS. MARCYRL PHARM... 130.50 EGP (4.35/unit) BIOFAXIMIN 200 MG 30 F.C. TAB. BIOPHARM EGYP... 188.00 EGP (6.27/unit) TRAVERIA 200 MG 10 F.C. TAB. WESTERN PHARM... 63.00 EGP (6.30/unit) FATROXIM 200 MG 30 F.C. TAB. EGPI > ATM PH... 243.00 EGP (8.10/unit) TRAVIGUARD 200 MG 20 F.C. TABS. DBK PHARMA > ... 162.00 EGP (8.10/unit) NORMIX 200 MG 12 F.C.TAB. ALFASIGMA > U... 134.50 EGP (11.21/unit) GASTROBIOTIC 200 MG 20 F.C.TAB. ANDALOUS PHARMA 243.00 EGP (12.15/unit) ANTIMOTILITY - give alongside 4. LOPERAMIDE [add-on - not a substitute] Adult 4 mg initially, then 2 mg after each loose stool, max 16 mg daily - Max 2 days Peds 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. 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. Caution CONTRAINDICATED in dysentery (bloody stools/high fever) and bacterial colitis — risk of toxic megacolon. Do not use for more than 48 hours. Egypt MOTIJUST 2 MG 30 CAPS INTERNATIONAL... 27.00 EGP (0.90/unit) STOPRRHEA 2 MG 10 ORODISPERSIBLE TABS. WESTERN PHARMACEUTICALS INDUSTRIE... 10.00 EGP IMODIUM INSTANT 2MG 6 ORODISPERSIBLE TABS. MCNEIL PRODUCTS LTD. > JOHNSO... 80.00 EGP STOPRRHEA 2 MG 30 ORODISPERSIBLE TABS. WESTERN PHARMACEUTICALS INDUSTRIE... 96.00 EGP REHYDRATION - give alongside 5. ORS [add-on - not a substitute] Adult Drink fluid/ORS solution after each loose stool - As needed Peds Encourage fluid replacement after every stool 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. Caution 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. Egypt GLUCOHYDRAN 10 SACHET. ARAB DRUG COM... 1.75 EGP REHYDRAN N 10 SACHET CID 4.50 EGP REHYDRO ZINC 10 SACHETS CID 7.00 EGP ORS 20 SACHETS PHAROPHARMA 40.00 EGP ELECTRO MASH SYRUP 200 ML MASH PREMIERE 60.00 EGP FLEXOLYTE ORAL REHYDRATION SOL. 240 ML KEMPETRO FOR CHEMICAL INDUSTRIES 65.00 EGP HERO ORS 200 ML HERO > HERO M... 120.00 EGP SANSO ORS SYRUP 140 ML AUG PHARMA 400.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)