Antibiotic prophylaxis for travellers' diarrhoea

The effectiveness of antibiotic prophylaxis for traveller’s diarrhoea is uncertain and prophylaxis is rarely indicated. Although antibiotic prophylaxis has been shown to reduce travellers’ diarrhoea episodes, many of the studies were performed before the emergence of multidrug-resistant bacteria. Consider potential harms of antibiotic therapy (eg adverse effects, increased risk of acquiring drug-resistant organisms and Clostridioides difficile [formerly known as Clostridium difficile] infection) before prescribing antibiotic prophylaxis for travellers’ diarrhoeaAdler, 2022Connor, 2024Kantele, 2015.

Consider antibiotic prophylaxis for travellers at risk of severe complications of diarrhoeal illness while travelling to settings with inadequate access to healthcare, clean water and sanitationAdler, 2022Connor, 2024. This includes people with immune compromise (eg advanced HIV infection, solid organ or bone marrow transplant recipients) and those in whom dehydration may exacerbate significant comorbidities (eg suboptimally managed heart failure).

If antibiotic prophylaxis for travellers’ diarrhoea is used, it should not be continued for longer than 3 weeks. If possible, consider local susceptibility data when choosing prophylaxis and seek expert advice. Quinolone antibiotics should be avoided for prophylaxis because of high levels of drug resistance and adverse effects. Counsel patients about the increased risk of colonisation with multidrug-resistant bacteria, particularly patients with immune compromise and those prone to urinary tract infectionConnor, 2024Langford, 2018.

Early treatment (eg stand-by self-treatment) of travellers’ diarrhoea may be preferred over antibiotic prophylaxis for high-risk travellers – see Indications for empirical antibiotic therapy for moderate or severe travellers’ diarrhoea.