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. 2009 Sep 9;15(10):1143–1238. doi: 10.1016/j.bbmt.2009.06.019

Pathogen: Traveler's diarrhea

Indication First Choice Alternatives

  • Prophylaxis among HCT recipients who are immunocompromised and who plan to travel in developing countries

  • Note: Administer for duration of stay in developing country

  • Adults/Adolescents:

  • Ciprofloxacin, 500 mg orally daily for the duration of stay in developing countries (BIII); or

  • Bismuth subsalicylate, 2 oz orally 4 times/day or 2 tablets orally 4 times/day for ≤3 weeks in adults  > 18 years old [824]

  • Pediatrics:

  • 150 mg trimethoprim/750 mg

  • sulfamethoxazole/m2/day by mouth as 2 divided doses 3 times/week on consecutive days (CIII)

  • Adults/Adolescents:

  • Trimethoprim-sulfamethoxazole,

  • 1

    double-strength (160/800 mg) tablet by mouth daily (CIII)

  • Pediatrics:

  • Trimethoprim-sulfamethoxazole, single dose orally 3 times/week on consecutive days

HCT indciates hematopoietic cell transplantation.

Notes: Use of aspirin-containing products, including bismuth subsalicylate, is contraindicated in persons <18 years old unless prescribed by a physician, because these products have been associated with Reye's syndrome [840].

Trimethoprim-sulfamethoxazole is not recommended for patients <2 months old, because of risk for kernicterus.

Resistance to trimethoprim-sulfamethoxazole is common in tropical areas.

Usual doses of trimethoprim-sulfamethoxazole for Pneumocystis jiroveci pneumonia prophylaxis should provide limited protection against traveler's diarrhea

Fluoroquinolones are not approved for use among children <18 years old.