GASTROINTESTINAL - Diarrhea, Acute, Traveler’s, Mild to Severe (Shigella, E. coli, Salmonella)

 

 

Ciprofloxacin

(Cipro®)

Pregnancy: C; Lactation: Unsafe

 

Tabs: 250 mg, 500 mg, 750 mg     Use with antimotility drug such as loperamide (Imodium®) if no fever or blood in stool.

 

>18 and Adult, Mild to Moderate: 750 mg PO × 1 dose. ³18 and Adult, Severe: 500 mg twice daily × 3 days.

 

Food: Take on empty stomach 1 hour before or 2 hours after a meal. May take with food if it causes GI upset, but avoid large amounts of dairy products. May take 2 hours before or 6 hours after sucralfate, antacids, aluminum, magnesium, calcium, zinc, iron, sucralfate, vitamins, or mineral supplements.

 

Important side effects: Photosensitivity, dizziness.

 

Reduce dose in renal disease (CrCl <50 mL/min).

 

 

Levofloxacin

(Levaquin®)

Pregnancy: C; Lactation: Unsafe

 

Tabs: 250 mg, 500 mg -    Use with antimotility drug such as loperamide (Imodium®) if no fever or blood in stool.

 

>18 and Adult, Mild to Moderate: 500 mg PO × 1 dose.

 

 >18 and Adult, Severe: 500 mg PO Q24H 3 days.

 

Food: May take with or without meals. Do not take within 2 hours of antacids,magnesium, calcium supplements, aluminum, sucralfate, vitamins, or minerals (iron or zinc).

 

Important side effects: Photosensitivity, dizziness.

 

Reduce dose in renal disease (CrCl <50 mL/min).

 

 

Azithromycin

Alternative for children and pregnant women.

 

(Zithromax®)

Pregnancy: B; Lactation: Unk

 

Tabs: 250 mg and Z-Pak (500 mg × 1 day, then 250 mg daily

 

 

Children³ 6 months:

5-10 mg/kg/day (max 500 mg) once daily for 5 days.

 

100 mg/tsp @ 10 mg/kg/day

10 kg (22 lb) = 1 tsp (5 mL) once daily for 5 days.

 

200 mg/tsp @ 10 mg/kg/day

20 kg (44 lb) = 1 tsp (5 mL) Q24H

30 kg (66 lb) = 1½ tsp (7.5 mL) Q24H

40 kg (88 lb) = 2 tsp (10 mL) Q24H

 >50 kg (110 lb) = Use adult dose.

 

Adult, Mild to Moderate: 1,000 mg × 1dose.

 

Adult, Severe: Dispense one Z-Pak.

 

 

Food: Oral suspension should be taken 1 hour before or 2 hours after food. Tablets may be taken without regard to

food.

 

Important side effects: Nausea, diarrhea, elevated LFTs.

Oral Susp: 100 mg/5 mL, 200 mg/5 mL

 

 

Trimethoprim/Sulfamethoxazole

(Bactrim®, Septra®) Generics available

Pregnancy: C; Lactation: Unsafe

 

Children: 6-12 mg/kg/day (trimethoprim

component, max 320 mg/day) in divided doses two times daily for 3-5 days.

 

40 mg/200 mg/5 mL @ 8 mg/kg/day

 

 

Food: May take without regard to food.

Encourage fluids.

Single Strength (SS) Tabs:

80 mg/400 mg

 

Double Strength (DS) Tabs:

160 mg/800 mg

 

Susp: 40 mg/200 mg/5 mL

10 kg (22 lb) 5 mL Q12H

20 kg (44 lb) 10 mL or 1 SS Tablet Q12H

30 kg (66 lb) 15 mL Q12H 1½ SS Tablet Q12H

40 kg (88 lb) 20 mL or 2 SS Tab or 1 Septra DS Q12H

 

Adult: 1 DS Tab PO Q12H for 3 days.

 

Important side effects: Photosensitivity,

rash.

 

Reduce dose in renal disease (CrCl <30 mL/min).