Cipro for India... What for?
 

I've read a few places that people are being perscribed Ciprofloxin for travel to India- what is it for??
I googled it, and it's normally perscribed for UTI's- is that common to get them there??

Thanks

Cipro is generally prescribed to take for cases of "Delhi-belly" - diarrhea, upset stomach...

My MD has me take it along wherever I travel in the world.

Our travel clinic told us that Zithromax is the preferred medication for traveler's diarrhea in India. If you have a cardiac condition, then Cipro is recommended.

The dosage for either is to take it for 3 days and then stop.

Roosevelt G.

Yes, we probably had "Z-packs", not Cipro for India but it really depends on what your doc favors...

Cipro has been used so much that there is significant antibiotic resistance in some places. For Thailand and Nepal, Cipro is no longer recommended, Zithromax is the currently recommended medication. Apparently, that is now true for India as well.

Kathie, thank you for your comment regarding Cipro resistance. I will certainly mention that to my doctor before he writes my prescription. I took a look at the CDC and NIH websites regarding TD. You practically have to have a medical degree to understand it.

There are two sections on the cdc website on TD - one for travelers, one for physicians. So make sure you are in the right section, as the section for physicians is quite technical.

The most important thing to know from that section are the food and water precautions. Drink only bottled water (make sure the seal is intact when you open it). In many places, you should brush your teeth with bottled water. And for food, peel it cook it (and eat it hot) or forget it. Make sure you wash your hands before eating or even touching your lips.

I know it sounds onerous, but accustom yourself to the precautions and they will become second nature when you travel.

Our travel doctor prescribed Zithromax and we will be taking it with us. However, I believe you can find it (azithromycin) in pharmacies through out the big cities.

I don't see this mentioned very often so I'll just throw it out...there are issues with cipro possibly causing tendon ruptures. My dr never cautioned me at all about that and is willing to prescribe cipro very readily.

from FDA site:
DA ALERT [7/8/2008]: FDA is notifying the makers of fluoroquinolone antimicrobial drugs for systemic use of the need to add a boxed warning to the prescribing information about the increased risk of developing tendinitis and tendon rupture in patients taking fluoroquinolones and to develop a Medication Guide for patients. The addition of a boxed warning and a Medication Guide would strengthen the existing warning information already included in the prescribing information for fluoroquinolone drugs.

Fluoroquinolones are associated with an increased risk of tendinitis and tendon rupture. This risk is further increased in those over age 60, in kidney, heart, and lung transplant recipients, and with use of concomitant steroid therapy. Physicians should advise patients, at the first sign of tendon pain, swelling, or inflammation, to stop taking the fluoroquinolone, to avoid exercise and use of the affected area, and to promptly contact their doctor about changing to a non-fluoroquinolone antimicrobial drug.

Selection of a fluoroquinolone for the treatment or prevention of an infection should be limited to those conditions that are proven or strongly suspected to be caused by bacteria.



http://www.webmd.com/osteoarthritis/...upture-tendons

http://www.fda.gov/drugs/drugsafety/.../ucm126085.htm

Leslie, thanks for posting this warning.

Levaquin, a fluoroquinolone antimicrobial which was the drug of choice for TD for a number of years is the drug most associated with tendon rupture.

I do like the last sentence, of the warning, but I'd expand it to include any antibiotic: Its use "should be limited to those conditions that are proven or strongly suspected to be caused by bacteria."

So when you receive an antibiotic for use for TD make sure you know when to use it. You don't take it because your stomach feels a little funny.

Remember our friend ...Pepto (when things are just a bit uncomfortable).

Hello all - I'm bumping this thread as it is similar to my question... My wife and I are going to Vietnam at the end of June. When we first started traveling to SE Asia, we took Cipro along for any TD, and thankfully, never needed it.

A few years ago, we also heard that most TD bacteria in SE Asia have become resistant to Cipro, and that most doctors now recommend Azithromycin (Zithromax or Z-pack).

Unfortunately, I found out a couple years ago that I am sensitive to Zithromax and can't take it, and then, just last year, found out the hard way that I shouldn't take Levaquin either - I took it for a sinus infection and wound up with "tennis elbow" for about 6 months!

So, my doctor and I have decided that I should stay off any of the fluoroquinolone family of antibiotics....

With that being said, does anyone know what I should take with me as a precaution? My doctor prescribed Xifaxan, but it seems to only treat a very limited number of varieties of E. Coli bacteria and nothing else... and I'm not really sure which bacteria I should be concerned with.

Of course, we always travel with Immodium and other OTC drugs - but if things get bad, an antibiotic is the way to go.

I appreciate any other thoughts!

I'd say that you should get your medical advice from your doctor, not from a travel forum. This is a more complex question than we can deal with here. I think you should also ask whether you should take any antibiotics along at all. Are you prone to getting TD? If so, you might consider preventive doses of Pepto-Bismol. Or, if you are in Canada, get Dukoral before you go. Unfortunately, it is not available in the US.

The most important thing you can do is to carefully adhere to food and water precautions.

I was issued the same warning re Cipro for Indonesia..but as I had a prior possible reaction to Azithromycin, they prescribed it to me anyways. I had only a mild case and treated it with bland diet and lomotil. I was able to avoid taking the Cipro by not eating anything for 24 hours, then starting with plain rice, adding in bananas, papaya and toast, chicken and noodle soups, and avoiding the greasier offerings and melon which always do me in.

For prevention I do use Pepto and probiotics. I am also cautious about things like welcome drinks, buffets with foods that may have been sitting around growing bacteria,cold scrambled eggs and cut fruit. Ironically the MD on our tour had major gut issues, took Cipro and it didn't work for him.

Thanks for both replies. Kathie, I understand your opinion - but, unfortunately, my doctor is just a standard NY internist - she's great for preventative medicine but she does not have a specialty in travel medicine, and she doesn't know any travel docs to ask... so she had not heard that the TD bacteria in SE Asia were largely resistant to Cipro by now.

I wasn't necessarily asking the forum for medical advice, but it seems that some people on the forum have doctors who are more knowledgable about travel related stuff, or there are people who frequent the forum who live in SE Asia, so their doctors would have the most up to date info (that's how I originally heard about Cipro not being effective).

The great thing about social media is the collective wisdom of the group - you never know if someone had a similar issue and received good advice.

khtodd--

Is there a travel clinic you can go to since you are in NY? We live in a large metropolitan area and have a general practice doctor but always make a special visit to a a travel clinic (that our insurance policy covers) prior to visiting under-developed countries.

I have Kaiser insurance, they have their own travel medicine department.

For mild cases of TD they suggest immodium (loperamide) 4mg followed by up to 16mg per day for up to 3 days. Or Pepto 2 tabs up to 8 doses per day.

With more than 3x in 8 hrs, or associated vomiting, fever or significant discomfort, they recommend the prescribed antibiotic WITH loperamide, as a single dose. If there is no result then seek medical attention (there are other things besides bacteria that can cause TD).

One of the side effects of the large dose azithromycin regimen is vomitting, which happened to me the one time I took it. So with that, the 3 day treatment may be better. I may ask about that if I travel to SE Asia again.

CDC has sections on TD if you want to read them, although they seem more oriented to travel advice providers.

https://wwwnc.cdc.gov/travel/yellowb...elers-diarrhea

I would have thought one of the universities or major hospitals in New York would have a travel clinic. If not, you can visit Passport Health.

https://www.passporthealthusa.com/new-york-city/

I always take Xipro and Zithromax when I travel anywhere out of the country(US.)

I agree with Kathie so my suggestion is either Google travel MD or clinic for one near you or hit the CDC website to see what is recommended currently for Nam and ask your MD to write a script for you. I've done that in the past and my MD has cooperated with me.

Also be sure to get a visa and more importantly get travel insurance with emergency evacuation coverage just to be sure.

The Cornell Clinic in NYC has an excellent travel med clinic. I'd go there before I'd go to Passport Health or any of the other for-profit travel clinics.

I agree, Passport Health has a tendency to push expensive jabs such as yellow fever which are not always necessary.

Khtodd - I now nothing about which antibiotics are effective in Vietnam, but many of the bigger pharmacies here are now really good and the pharmacists very helpful. If you are unable to source reliable advice in the US then I wouldn't worry too much as they will be able to advice on which antibiotics are effective.

There are decent pharmacies in all the major cities, Saigon, Hanoi, Da Nang, Hue. They will be in all the main tourist areas and around the hospitals. You could easily obtain a course of antibiotics on arrival just in case.

There used to be an issue with counterfeit meds, but that seems to be less of a problem ( although I would be wary of the smaller, back street pharmacies.

The fact that they issue antibiotics without prescription is very concerning, especially as they will sell them to you as single pills rather than a whole course. A recipe for disaster!

Thank you everyone for your thoughts. After further research, it appears that over 80% of all TD is caused by a few strains of E. Coli found in food (not water)... and the Xifaxan prescribed by my internist can treat those strains. So, hopefully, that will be enough for me...

crellston - thanks for that info - I don't know if I would have thought of trying a local pharmacy and asking about that - but now, it is surely going to be an option if necessary.