Indications for empirical antibiotic therapy for moderate or severe travellers' diarrhoea

Empirical antibiotics are effective in reducing the duration of travellers’ diarrhoea by up to 2 days in episodes caused by drug susceptible bacteriaConnor, 2024. Consider treating patients with:

• severe travellers’ diarrhoea, particularly when features of bacterial infection are present (eg fever [38°C or higher], severe abdominal pain, mucus in the stool)
• moderate or severe travellers’ diarrhoea who are at increased risk of complications, including patients with immune compromise (eg advanced HIV, solid organ or bone marrow transplant recipients) and those in whom dehydration may exacerbate significant comorbidities (eg suboptimally managed heart failure).

Use of antibiotics for early treatment (eg stand-by self-treatment) of moderate or severe travellers’ diarrhoea should be reserved for people at increased risk of complications (see above) while travelling in settings with inadequate access to healthcare. Appropriate use of early treatment relies on adequate self-diagnosis while travelling; evidence suggests that early treatment is often misused and does not reduce visits to local healthcareVilkman, 2019. Before prescribing early treatment of travellers’ diarrhoea, consider the potential harms of antibiotic therapy (eg adverse effects, increased risk of acquiring drug-resistant organisms and Clostridioides difficile [formerly known as Clostridium difficile] infection) and the uncertain benefit of treating an infection that is usually self-limitingVilkman, 2019.