Rifamycin Delayed-Release (Aemcolo™)

SELF ADMINISTERED - ORAL

Indications for Prior Authorization:
  • Treatment of travelers' diarrhea (TD) caused by non-invasive strains of Escherichia coli in adults

     Limitations : Amecolo is not indicated in patients with diarrhea complicated by fever or bloody stool or due to pathogens other than noninvasive strains of Escherichia coli

Patients must meet the following criteria:
  • Diagnosis of travelers' diarrhea
  • Member is at least 18 years of age or older
  • Trial and failure of ciprofloxacin or azithromycin
Dosing:
  • 388 mg twice daily for 3 days
Approval:
  • 1 treatment

Last review date: December 9, 2019

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