This information was taken from recommendations from the Center for Disease Control and International Society of Travel Medicine recommendations.

Definition of Traveler’s Diarrhea (TD)

  • Mild : diarrhea that is tolerable,  is not distressing, and does not interfere with planned activities.
  • Moderate: diarrhea that is distressing or interferes with planned activities. Diarrhea accompanied by nausea, cramping, vomiting, low-grade fever.
  • Severe: diarrhea that is incapacitating, or completely prevents planned activities; high fever, frequent vomiting, severe cramping. All stools that are grossly bloody are considered severe (dysentery).
  • Persistent: diarrhea lasting > 2 weeks.

Current recommendations for treatment are based on these categories, a change from treating TD based on the number of loose stools in a day.

Treatment Recommendations

Prophylaxis (prevention)

  1. Antibiotics should not be used for prevention routinely in travelers.
  2. Antibiotics should be considered for travelers at risk of health related complications from TD.
  3. Bismuth subsalicylate (BSS, Pepto-Bismol) may be considered for prevention.  Dosage: 2 tablets 4x/day, or 30 ml of liquid. Possible side effects:  black tongue, constipation, some drug interactions.

Mild diarrhea

  1. Antibiotics not recommended.
  2. Loperamide or BSS may be considered.

Moderate diarrhea

  1. Antibiotics may be used to treat cases of moderate TD.
  2. Azithromycin 1 Gram for one dose may be given, or 500 mg once a day x 3 days. Take with food to minimize upset stomach.
  3. Fluorquinolones (Cipro, Levaquin) may be used, however emergence of significant resistance in SE Asia, potential for adverse reduction in intestinal healthy microbiota, and musculoskeletal consequences contribute to an uncertain risk-benefit profile.
  4. Loperamide along with antibiotics, or as a single monotherapy has also been shown to be effective.

Severe TD

  1. Antibiotics should be used to treat severe TD.
  2. Azithromycin is preferred, in a single dose regimen.
  3. Fluorquinolones (Cipro, Levaquin) may be used to treat non-dysenteric diarrhea, but with a weak recommendation.
  4. Rifaximin may be used to treat severe TD

There is not enough data currently to recommend probiotics or pre-biotics to prevent or treat TD.

There is increasing evidence that untreated TD with prolonged diarrhea may cause increase incidence of Irritable Bowel Syndrome (IBS).


  1. CDC Yellow Book on Traveler’s Diarrhea
  2. Riddle, M., Conner, B., Beeching, N., Dupont, H., Hamer, D., Kozarsky, P., et al. (2017). Guidelines for the prevention and treatment of travelers’ diarrhea:  a graded expert panel report.  Journal of Travel Medicine, Vol  24, Suppl 1, S63-S80.  doi:  1093/jtm/tax026