Antinal (nifuroxazide): what tourists in Egypt should know

Antinal is a brand of nifuroxazide, an antibacterial medicine that acts mainly inside the gut. It is sold in Egypt for acute diarrhoea, but most traveller’s diarrhoea gets better with fluids and oral rehydration salts. Some people should not take nifuroxazide at all.

This guide is for visitors who are thinking about taking Antinal in Egypt. It covers what the medicine is, what the evidence shows, and when to see a doctor instead.

What is nifuroxazide?

Nifuroxazide belongs to the nitrofuran family of antibacterial medicines. It has been widely used since the 1960s.

Brand names differ by country. In France it has been sold as Ercefuryl and as generics, and in Poland under names such as Nifuroksazyd.

In France, its approved use is acute diarrhoea thought to be caused by bacteria. It is only for cases with no signs of a more serious, invasive infection. Those signs include fever and feeling generally very unwell.

In Egypt, Antinal comes as capsules and as a liquid suspension. You will find it in our pharmacies.

How is it thought to work?

The exact mechanism is not known. Nifuroxazide is thought to block enzymes and protein production inside some bacteria.

It reaches high levels inside the gut, where it acts against some common gut bacteria. It has shown no clinical benefit in diarrhoea caused by viruses.

For years, it was described as staying in the gut. Updated European product information from 2022 says about 10–20% of a dose is absorbed into the body.

This matters for travellers. Bacteria cause most cases of traveller’s diarrhoea, but viruses such as norovirus cause some cases too.

What does the evidence say?

The evidence is limited and mostly old. A 1989 double-blind trial included 88 adults. Diarrhoea lasted about 2.1 days with nifuroxazide and about 3.3 days with a placebo.

A small 2022 study in 61 adults found faster improvement than with a probiotic. It did not compare nifuroxazide with a placebo.

For children, France’s medicines agency (ANSM) concluded that the clinical studies were insufficient.

Travel-health guidance from the US CDC and the UK NHS does not list nifuroxazide. Their advice focuses on fluids and oral rehydration, with other medicines for selected cases.

Rules differ between countries

In July 2019, France made nifuroxazide prescription-only. It must not be used in children and teenagers under 18. The reasons were allergic reactions, which can be life-threatening, and widespread misuse.

Reported side effects include severe allergic reactions, skin reactions such as sensitivity to sunlight, and rare blood problems. In a sunny place like Sharm, the sun sensitivity is worth knowing about.

In 2022, EU regulators added a warning after a review by the European Medicines Agency’s safety committee. Nifuroxazide may be able to damage genetic material, so it is not recommended in pregnancy or breastfeeding.

Lists published by the European Medicines Agency in 2020 and 2022 name nifuroxazide products in a handful of EU countries. They include France, Poland, Greece, Romania and the Czech Republic.

In Egypt, Antinal is sold in pharmacies. The rules here differ from those in France, so ask a pharmacist before you take it.

Who should not take it?

Do not take nifuroxazide without medical advice if:

• you are allergic to nifuroxazide or to other nitrofuran medicines
• the medicine is for a child
• you are pregnant or breastfeeding, or could become pregnant and do not use effective contraception
• you have a fever, blood in your stool or feel very unwell, because these signs need a doctor
• you plan to drink alcohol, because it can cause a reaction similar to the one caused by disulfiram

Stop taking it at once if you get a rash, itching, breathlessness or swelling of the face, lips or tongue. Breathing problems or swelling need emergency help.

European product information also advises against taking other oral medicines at the same time. Tell the pharmacist about everything you take.

Fluids come first

In adults, diarrhoea usually stops within 5 to 7 days. Without treatment, bacterial traveller’s diarrhoea usually lasts 3 to 7 days, and viral diarrhoea 2 to 3 days.

The most important step is to drink plenty of fluids. Oral rehydration salts replace lost water and salts. Mix them with bottled or boiled water, exactly as the pack says.

Avoid fruit juice and fizzy drinks. Eat when you feel able to. Do not use a swimming pool until 48 hours after your symptoms stop.

For children, fluids are the main treatment, and there is usually no need for medicine. Read our full guide to traveller’s diarrhoea in Egypt, and see our first-aid and rehydration basics.

Lowering your risk

Simple habits lower the risk of traveller’s diarrhoea, although they cannot remove it completely. Wash your hands with soap before eating. When there is no soap, use a hand sanitiser with at least 60% alcohol.

Choose food that is served hot, or that is dry or packaged. Drink bottled, canned or hot drinks, and only pasteurised milk.

Taking antibiotics “just in case” is not recommended for most travellers. They can cause side effects and help drug-resistant bacteria to spread.

What about the dose?

We do not give doses online. Follow the leaflet in the pack, and ask our pharmacist if you are unsure. Our Russian-speaking pharmacists can explain the leaflet in Russian, English, Ukrainian or Italian.

Need help in Sharm?

Not sure whether Antinal suits you? Message our pharmacists on WhatsApp or call +20 120 344 2201, in English, Russian, Ukrainian or Italian. Hotel delivery is free for orders from $30.