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Azithromycin is effective in reducing the symptoms of travellers' diarrhoea, particularly if taken with loperamide. This is an off-label use of azithromycin, but it has been prescribed for travellers' diarrhoea for many years. The symptoms of travellers' diarrhoea should improve within 24 hours of starting antibiotics.

It is recommended that you consider carrying standby antibiotics for travellers' diarrhoea:

• Travel to a high risk country which includes Africa, Latin America, the Middle East, and most parts of Asia.
• If you are going to a remote location with little or no access to good medical assistance.
• If you are at high risk of the diarrhoea leading to severe illness, e.g. poorly controlled diabetes, renal impairment, heart failure, or another condition causing reduced immunity.
• If you have a pre-existing bowel problem where infection may trigger a relapse, e.g. ulcerative colitis, Crohn's disease, and previous bowel surgery.

Dr Fox limits orders for azithromycin for travellers' diarrhoea to a maximum of 1 order in 3 months as they should not be taken regularly to reduce the risk of antibiotic resistance.

For further information see NHS - Azithromycin.

How to take azithromycin

Treatment with azithromycin is one 500mg tablet daily for 3 days. Start as soon as you get diarrhoea, not before. It is not a preventative.

The tablets should be taken with a glass of water, with or without food, at the same time of day.

Cautions

If you have a known allergy to azithromycin, erythromycin, or clarithromycin you should not take azithromycin for travellers' diarrhoea.

There are some medical conditions where you should not take azithromycin:

• A tendency to irregular heartbeat.
• Myasthenia gravis.
• Liver disease.
• Severe kidney disease.

It is not recommended to take azithromycin when trying to conceive, or during pregnancy and breastfeeding, without first discussing it with your own GP. See Best use of medicines in pregnancy - Azithromycin for further information.

Azithromycin tablets contain lactose.

Other medicines and azithromycin

Do not use the following medications at the same time as azithromycin:

• Larium (mefloquine) - used for malaria prevention.
• Avomine (promethazine) - an anti-sickness medication.
• Please check this list and the patient information leaflet for other medications which have a possible risk of causing an abnormal heart rhythm.

You may be able to take azithromycin but you should consult your own GP if you are taking the following medications:

• Ciclosporin - for reducing immunity after transplant.
• Digoxin - for irregular heart or heart failure.
• Terfenadine - antihistamine for hay fever and allergy.
• Theophylline - for asthma, used rarely.
• Rifabutin - anti-tuberculosis antibiotic used rarely
• Colchicine - for gout.
• Warfarin, edoxaban, ticagrelor, or any similar medicines - to prevent blood clots.
• Talazoparib, topotecan - specialist cancer drugs.
• Quinolone antibiotics, e.g. moxifloxacin, levofloxacin, ciprofloxacin.
• Hydroxychloroquine or chloroquine - used for autoimmune diseases such as rheumatoid arthritis or to treat malaria.

Antacids for indigestion can be taken but leave at least 2 hours after taking the antacid before taking azithromycin.

Side effects

If there are any side effects the most common are stomach upset, headache, nausea, and diarrhoea. For more details see the patient information leaflet supplied with the tablets.

Seeking help

Symptoms should start to improve within 24 hours of starting azithromycin. Medical advice should be sought if symptoms are not improving after 2 or 3 days, or are worsening, or if any of the following occur:

• Profuse diarrhoea and vomiting leading to dehydration.
• Blood and green or yellow slime in the motions with severe abdominal pains.
• Diarrhoea associated with rashes.
• High fever and headache with diarrhoea (particularly in malarial areas).

Managing the symptoms of diarrhoea

• The antidiarrhoeal loperamide can also reduce symptoms.
• Try to get plenty of rest.
• Drink plenty of fluids, even if vomiting (at least 3-4 litres daily).
• Continue to eat simple foods such as rice and dried bread, appetite permitting.
• Pay attention to personal hygiene, to prevent spread.

Antibiotic guardianship

To combat antibiotic resistance please:

• Only use antibiotics when needed.
• Never share antibiotics.
• Always complete course as instructed.
• Take unused medicine to local pharmacy for disposal.

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