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Authors and Disclosures
P. Layer & V. Andresen Department of Medicine, Israelitic Hospital, Hamburg, Germany Correspondence to Dr P. Layer, Department of Medicine, Israelitic Hospital, Orchideenstieg 14, 22297 Hamburg, Germany. E-mail: email@example.com
From Alimentary Pharmacology & Therapeutics
Review Article: Rifaximin, a Minimally Absorbed Oral Antibacterial, for the Treatment of Travellers' Diarrhoea
P. Layer; V. Andresen Posted: 06/30/2010; Alimentary Pharmacology & Therapeutics. 2010;31(11):1155-1164. © 2010 Blackwell Publishing
Abstract and Introduction
Background Travellers' diarrhoea, a common problem worldwide with significant medical impact, is generally treated with anti-diarrhoeal agents and fluid replacement. Systemic antibiotics are also used in selected cases, but these may be associated with adverse effects, bacterial resistance and drug–drug interactions. Aim To review the clinical evidence supporting the efficacy and safety of the minimally absorbed oral antibiotic rifaximin in travellers' diarrhoea. Methods PubMed and the Cochrane Register of Controlled Clinical Trials (to January 2010) and International Society of Travel Medicine congress abstracts (2003–2009) were searched to identify relevant publications. Results A total of 10 publications were included in the analysis. When administered three times daily for 3 days, rifaximin is superior to placebo or loperamide; it is at least as effective as ciprofloxacin in reducing duration of illness and restoring wellbeing in patients with travellers' diarrhoea, both with and without identification of a pathogen, as well as in diarrhoea caused by Escherichia coli infection. Rifaximin demonstrates only minimal potential for development of bacterial resistance and for cytochrome P450-mediated drug–drug interactions, and its tolerability profile is similar to that of placebo. Conclusion When antibiotic therapy is warranted in uncomplicated travellers' diarrhoea, rifaximin may be considered as a first-line treatment option because of its favourable efficacy, tolerability and safety profiles.
Travellers' diarrhoea (TD) is a clinical syndrome frequently encountered by individuals (e.g. holidaymakers, business travellers, military personnel) visiting certain regions of the world, particularly the Middle East, Southern Asia, South and Central America, and Africa. The incidence of TD varies between specific locations, ranging between 20% and 90% for these regions and is calculated to affect 15–20 million travellers each year worldwide.[2–4] Travellers' diarrhoea is characterized by acute diarrhoea, often accompanied by nausea, vomiting, abdominal cramps and fever, because of the translocation of fluid and salts from the vascular to the mucosal side of the gut, where they are lost. The impact of TD involves not only significant morbidity but also interruption to plans and daily activities.[1–3, 5, 6] In a majority of cases, symptoms last 3–4 days;[2, 3] however, in some instances, affected individuals may experience persistent diarrhoea lasting more than 2 weeks. In addition, more than 10% of people experiencing TD may go on to develop postinfectious irritable bowel syndrome (PI-IBS). The primary causative agents of TD are pathogenic enteric bacteria, most commonly enterotoxigenic Escherichia coli (ETEC), enteroaggregative Escherichia coli (EAEC), Campylobacter jejuni, Salmonella species and Shigella species.[9–12] However, prevalence of the bacteria causing TD differs between geographical locations and up to 40% of TD cases are of unknown aetiology, even after comprehensive microbiological evaluation.[6, 10, 13]
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abstracts from the meetings of the International Society of Travel Medicine (ISTM. plus chemoprophylaxis with bismuth salts. 26–28] Notably.medscape. such as ETEC. coli and Shigella isolates from subjects with TD to other (older) antibacterials. there are differences in efficacy between antibiotic agents. The in vitro inhibitory potency of rifaximin against the majority of bacterial pathogens responsible for TD (ETEC. In this article. resistance to fluoroquinolone antibacterials among many of the pathogenic bacteria causing TD. Interest in the prevention of TD is increasing because of an increase in the number of individuals visiting tropical and developing countries. vs. 14] A systematic review of clinical studies (completed up to the year 2000) has concluded that antibiotic therapy for TD is associated with a reduction in frequency of unformed stools passed at 24-h intervals (i. 30–33] Importantly. tetracycline. These include specific targeted activity at the infection site/poor systemic absorption. probiotics or selected antibiotics. the high rates of TD among such visitors and postdiarrhoea complications such as PI-IBS. plus a low potential for side effects. 29] Antibacterials that are not absorbed into the systemic circulation have demonstrated efficacy as anti-diarrhoeal agents and may be associated with a more favourable safety/tolerability profile because of their minimal systemic exposure.e. most commonly dizziness and headache.[18–21] In addition. difficile strains to rifaximin is also uncommon.[9. Specific groups of travellers who should be considered as candidates for chemoprophylaxis include those with underlying chronic medical illnesses. case reports and meta-analyses).com/viewarticle/721697_print Following anti-diarrhoeal agents and fluid replacement.[13. treatment of TD includes empirical broad-spectrum oral antibiotic therapy. are well absorbed into the systemic circulation after oral administration. such as fluoroquinolones. thus limiting their utility. no treatment (placebo). 34] By contrast. other factors should be considered when selecting an appropriate antibacterial treatment. In addition. Resistance of C. chloramphenicol and ampicillin is well documented and these agents are no longer considered an appropriate treatment for TD.[23. 15] drug interactions and development of antibacterial resistance. A recent systematic review of the literature states that prevention consists of avoiding food and beverages that may potentially be contaminated.[30. 24. C. a known susceptibility to diarrhoea and previous TD. Shigella and Salmonella species. the percentage of resistant enteric bacterial isolates has increased over time. Shigella species and Salmonella species has been reported in many countries around the world. However. all the MIC90 values for rifaximin against these bacteria are several times lower than the concentrations of rifaximin excreted in the faeces and therefore achieved within the gut. EAEC. and to minimize person-to-person spread of TD. Bacterial resistance to rifaximin is low. rifaximin is unlikely to be effective against invasive bacterial strains responsible for TD.[22–26] Resistance of faecal E. we review the literature supporting the efficacy and safety of rifaximin in the treatment and prevention of TD. 2003–2009) were also searched. Results Studies Identified 2 of 11 02-05-2011 19:55 . severity) and a significantly increased likelihood (around sixfold) of achieving resolution of diarrhoea and other symptoms (clinical cure) within 72 h of treatment initiation. All articles containing clinical data concerning the efficacy and safety of rifaximin in TD were reviewed by the authors (including randomized controlled trials. Clostridium difficile) has been demonstrated in a number of studies.Rifaximin for the Treatment of Travellers' Diarrhoea (printer-friendly) http://www. such as the fluoroquinolones. with only a short course of treatment.[17. The goal of treatment is to achieve a rapid resolution of diarrhoea. Methods References for this review were identified by searches of PubMed and the Cochrane Register of Controlled Clinical Trials to January 2010 using the terms 'rifaximin' and 'diarrhoea/diarrhea' (with no language restrictions). Many antibacterials. 18] This may be associated with an increased risk of systemic adverse effects. such as trimethoprim-sulfamethoxazole (co-trimoxazole). and long-term monitoring of the faeces of study participants has demonstrated that the small number of rifaximin-resistant bacterial strains observed following treatment disappear from the gut rapidly (1–2 weeks) after treatment discontinuation. Reference lists from review articles were also checked for additional papers. and more rarely.[26. hepatic dysfunction or psychiatric adverse effects.[10. Rifaximin is a minimally absorbed oral antibacterial available in several countries around the world for the treatment of acute bacterial diarrhoea. observational studies. including those resistant to more than one class of antibacterial agent. jejuni. In addition to broad-spectrum activity against a range of bacterial enteropathogens and efficacy against the symptoms of TD. because of its poor systemic absorption. to minimize disruption to planned activities.
co-trimoxazole) 47. 20 were positive for pathogens (ETEC. 600 mg t. Shigella. 5 days 3 of 11 02-05-2011 19:55 .d. but on review.d.0 h for rifaximin 600 mg 35.0 h for co-trimoxazole Improvement in diarrhoea* at 24 h 56% for rifaximin 200 mg 44% for rifaximin 400 mg 53% for rifaximin 600 mg 65% for co-trimoxazole At 48 h 83% for rifaximin 200 mg 78% for rifaximin 400 mg 89% for rifaximin 600 mg 76% for co-trimoxazole DuPont 72/Mexico et al. rifaximin 600 mg t.s. time from start of treatment to resolution of diarrhoea) was similar for rifaximin 400 mg t. Co-trimoxazole 160/800 mg b.  Randomized controlled trial 200 mg t.d.s. US students suffering from TD were randomized to receive one of: rifaximin 200. the information contained in these had subsequently been published in full.s. than co-trimoxazole.d.com/viewarticle/721697_print From the literature searches.s. Median time to last unformed stool (TLUS.d. Salmonella.medscape. However.S.[31.d. However. vs. 400 or 600 mg (all t. compared with organism eradication for 100% of pathogens with co-trimoxazole. and co-trimoxazole. Improvement in diarrhoea at 24 h after treatment initiation was achieved by slightly fewer patients receiving rifaximin. a total of 122 articles were identified.d.5 h for rifaximin 400 mg 35. 38–46] From the ISTM abstracts. Efficacy of Rifaximin for the Management of TD The clinical efficacy of rifaximin in the treatment of TD has been evaluated in a number of clinical trials (Table 1).s. In all patients receiving rifaximin.d.s.).Rifaximin for the Treatment of Travellers' Diarrhoea (printer-friendly) http://www.d.d. Table 1. at 48 h. and 600 mg t.s. 10 were selected for further review. The articles discounted were primarily reviews containing no new clinical data or studies examining the in vitro antimicrobial activity of rifaximin. Following review of the abstracts by the authors. Cryptosporidium or Campylobacter species were identified in pre-treatment stool samples) and this was reduced by 80% after treatment. i.s. Summary of clinical studies evaluating rifaximin in travellers' diarrhoea Study Number of patients/countries visited Study design Rifaximin Control group dose Treatment length Key results Treatment Median TLUS 26.0 h for all rifaximin groups (N.s. compared with patients receiving co-trimoxazole. all enteropathogens were eradicated with rifaximin 200 mg t.. 400 mg t.3 h for rifaximin 200 mg 40.) for 5 days.d. these percentages had increased in all groups. or co-trimoxazole 160 mg/800 mg twice daily (b. three were selected. In an early study performed in Mexico.e. but were higher for rifaximin 200 mg t.
medscape.com/viewarticle/721697_print Eradication rate of enteropathogens 100% for rifaximin 200 mg 60% for rifaximin 400 mg 50% for rifaximin 600 mg 80% for all rifaximin groups 100% for co-trimoxazole Median TLUS 25.d.001 vs.0 h for rifaximin 200 mg (P = 0.0 h for ciprofloxacin (95% CI: 18. placebo) 81. ciprofloxacin) 88% for ciprofloxacin Adverse events 31 (33%) for rifaximin 34 (36%) for ciprofloxacin Median TLUS 32.2) Clinical cure† 87% for rifaximin (N. 3 days Steffen 380/Guatemala.  Mexico and Kenya Randomized controlled trial 200 mg t.0% for rifaximin 400 mg (P = 0.Rifaximin for the Treatment of Travellers' Diarrhoea (printer-friendly) http://www.s. vs.9–38. placebo) 60. placebo) 32. Placebo t. placebo) 60.  Jamaica Randomized controlled trial 400 mg b. vs.0) (N. ciprofloxacin) 25.5% for placebo Improvement in DuPont 187/Mexico and et al.S.d.d. 400 mg t.5–35.7 h for rifaximin (95% CI: 20.s. ciprofloxacin) 88% for ciprofloxacin Eradication rate for all pathogens 74% for rifaximin (N.S.S. et al. 3 days 4 of 11 02-05-2011 19:55 .001 vs.d.s.d.0001 vs. Ciprofloxacin 500 mg b.9 h for rifaximin 400 mg (P = 0. vs.0 h for placebo Clinical cure† 79.2% for rifaximin 200 mg (P = 0.0001 vs.
Mexico.65) Clinical cure† 76.63 (95% CI: 1.008 vs. P = 0. vs.5 h for placebo Risk ratio for rifaximin vs.d. N.7% for ciprofloxacin (P = 0. placebo) 65.8%) for placebo group Median TLUS 32.19) Risk ratio for ciprofloxacin vs. India and Peru Randomized controlled trial 200 mg t.com/viewarticle/721697_print diarrhoea* at 48 h‡ 87% for rifaximin 200 mg (P = 0.5 h for rifaximin (P = 0.007 vs.7%) for rifaximin 400 mg 90 (69. ciprofloxacin) 78.6% for rifaximin (N.89 (95% CI: 1.d.8 h for ciprofloxacin (P = 0.. placebo.S.6% for rifaximin (P = 0. placebo 3 days 5 of 11 02-05-2011 19:55 . placebo = 1. ciprofloxacin) 80.7%) for rifaximin 200 mg 88 (69.s.34–2.Rifaximin for the Treatment of Travellers' Diarrhoea (printer-friendly) http://www.0002 vs.001 vs. placebo) 78% for placebo Drug-related adverse events 74 (59. ciprofloxacin) 28. 399/Guatemala.001 vs.0003 vs. vs. placebo) 51. placebo = 1.S.2% for ciprofloxacin (P < 0.medscape. placebo) 72% for placebo At 72 h 91% for rifaximin 200 mg (P = 0.4% for placebo Eradication rate for all pathogens 61. placebo.S. vs.001 vs. placebo. placebo) 61.21–2.05 vs. Ciprofloxacin 500 mg b.7% for placebo Adverse events Taylor  et al. N.
rifaximin–loperamide = 1.002 vs.72 for loperamide (P = 0.56 (95% CI: 0.d.Rifaximin for the Treatment of Travellers' Diarrhoea (printer-friendly) http://www.84–2.6%) for rifaximin 25 (25.medscape. Loperamide 4 mg initially and then 2 mg after each unformed stool Rifaximin and loperamide combination therapy 3 days 6 of 11 02-05-2011 19:55 .26–4.5 h for rifaximin (P = 0.76 (95% CI: 1.0019 vs.3 h for rifaximin–loperamide (P = 0.0 h for loperamide Clinical cure§ 77% for rifaximin 75% for rifaximin– loperamide 58% for loperamide Odds ratio for rifaximin and rifaximin vs. loperamide) 69.49 (95% CI: 0.  Randomized controlled trial 200 mg t.76) DuPont 311/Mexico et al. loperamide = 1.99 for rifaximin– loperamide 6.0019 vs.s. rifaximin– loperamide) Eradication rate of all pathogens 76% for rifaximin 68% for rifaximin– loperamide 67% for loperamide Odds ratio for rifaximin vs.70) Mean number of unformed stools passed during illness 6.23 for rifaximin (P = 0.0%) for ciprofloxacin 24 (24.com/viewarticle/721697_print 53 (26.0%) for placebo Median TLUS 32. loperamide) 27. loperamide = 1. rifaximin–loperamide) 3.80–2.89) Odds ratio for rifaximin vs.004 vs.
group than in the placebo group.s. enterotoxigenic Escherichia coli.0% for placebo DuPont 219/Mexico et al. the difference was not statistically significant. twice daily. US students visiting Mexico or Jamaica received either rifaximin 400 mg b. baseline. Although the percentages of patients achieving improvement with rifaximin 400 mg t.s.  Randomized controlled trial 200 mg OD 200 mg b. but the difference between rifaximin 200 mg t.d. (P < 0. placebo) 19.d.d.d. or ciprofloxacin 500 mg b. At 72 h after treatment initiation.001 vs.d.d.s. N.com/viewarticle/721697_print Prevention Occurrence of TD 12. (P < 2-week 0. In a multicentre study involving 380 individuals with TD in Guatemala. For this population. three times a day. At 72 h.S. were compared with placebo over a 3-day treatment period. Median TLUS was shorter for those receiving rifaximin (33 h. CI.d. placebo) 48. and 400 mg t.7% for all rifaximin groups (P < 0.03).s. and placebo remained significant. In a separate randomized. ETEC. TLUS.. 95% CI: 15–25 h) than those receiving placebo (72 h. or rifaximin 400 mg t. ‡ Percentages for 400 mg rifaximin not provided. once daily.s.  Randomized controlled trial 600 mg OD Placebo b. TD.1% for rifaximin groups 40. these percentages had increased in both treatment arms.d. maximum two soft stools and no clinical symptoms) was achieved at day 5 in similar proportions of patients receiving rifaximin 200 mg t. 95% CI: 19–47 h) 7 of 11 02-05-2011 19:55 . * Defined as the passage of 50% or fewer stools during a 24-h period vs.7% for placebo ETEC pathogens after treatment 7. baseline) was achieved at 48 h by significantly more patients in the rifaximin 200 mg t. A subsequent analysis from this study investigated the efficacy of rifaximin in TD caused by EAEC in the subgroup of patients (n = 43) who remained ill during the study (5 days after initiation of therapy).001 vs.7% for placebo Occurrence of TD 20.medscape.d.. Mexico and Kenya.d. t. defined as 48 h with no unformed stools and no fever. Median TLUS was significantly lower in both rifaximin groups than in the placebo group.0% for rifaximin 2-week 600 mg OD (P < prophylaxis 0.001 vs. similar high percentages of patients receiving rifaximin or ciprofloxacin had achieved a clinical cure. Improvement in diarrhoea (defined as the passage of ≤50% stools during a 24-h period vs.0001 vs. time to last unformed stool.0% for rifaximin 200 mg OD (P < 0. for 3 days. nonsignificant. placebo) 53. both were significantly superior to placebo.. placebo) 13.d. † Wellness.d. placebo) prophylaxis 14.s.2% for rifaximin 200 mg b. double-blind. travellers' diarrhoea. Median TLUS was comparable for rifaximin and ciprofloxacin.001 vs.s. confidence interval. median TLUS was significantly shorter for those receiving rifaximin (22 h. maximum two soft stools and no clinical symptoms. or 24 h without watery stools.d.s.d.. No statistically significant differences between treatments were observed. For those patients remaining ill during the study and for whom no pathogenic cause of TD was identified. similar results were obtained.Rifaximin for the Treatment of Travellers' Diarrhoea (printer-friendly) http://www. or 24 h without watery stools. § Defined as TLUS <120 h.s.s.. were numerically higher than those with placebo. defined as 48 h with no unformed stools and no fever. 95% CI: 20–72 h) (P = 0. rifaximin 200 mg t.0% for rifaximin 200 mg t.d. double-dummy study. OD. Placebo DuPont 210/Mexico et al. Clinical cure (wellness. 200 mg t.
but without invasive pathogens. P = 0. In a placebo-controlled study.s. for 3 days) has been compared with that of loperamide monotherapy (4 mg initially followed by 2 mg after each unformed stool) and rifaximin + loperamide in TD. There were no differences between active treatments for achievement of clinical cure. in individuals with TD. indicating no significant development of resistance during this time period.d. 39% of ETEC isolates were resistant to TMP.5 µg/mL. but this difference was not statistically significant. the tolerability profile of rifaximin was generally similar to that of placebo. 399 individuals with TD in Mexico. defined in this study as TLUS <120 h. but there were no differences between the active treatments. In a separate randomized. In the study comparing rifaximin with co-trimoxazole.Rifaximin for the Treatment of Travellers' Diarrhoea (printer-friendly) http://www.d. 219 US adults received a 2-week course of rifaximin 200 mg/day. or 200 mg t. Significantly more individuals receiving placebo than rifaximin experienced TD during this time. (n = 100) Any adverse event 26. 95% CI: 0.d. 200 mg b. in more than 300 US students visiting Mexico.d. and a significantly greater proportion of patients achieved clinical cure with rifaximin than with placebo (77% vs. Across all pathogens identified. The incidence of ETEC-related TD was reduced by 83% for rifaximin vs.medscape. a protection rate of 72% against TD with rifaximin was observed (P < 0. controlled trial in travellers' diarrhoea Rifaximin 200 mg t. double-blind. Clinical cure. Rifaximin monotherapy and combination therapy significantly reduced median TLUS vs. A separate randomized. At the end of day 1. eradication rates were significantly higher for ciprofloxacin vs. Adverse events were reported for 24–27% of patients receiving each drug. or placebo. 95% CI: 40–78 h). coli. Rifaximin in the Prevention of TD Rifaximin has also been evaluated as a chemoprophylactic agent. and 400 mg t.67) or loperamide monotherapy (odds ratio = 1. 61%.[39. rifaximin demonstrates a similar tolerability profile (Table 2).[31.s. Those receiving rifaximin were significantly less likely to develop TD compared with those receiving placebo..d. Guatemala. Median TLUS was also significantly reduced with rifaximin vs. and these were mild and nonspecific (headache.0015).6 24. was achieved more frequently with rifaximin monotherapy or combination therapy than with loperamide alone.d.0 8 of 11 02-05-2011 19:55 .s. placebo-controlled trial involving 210 travellers to Mexico compared rifaximin 600 mg OD with placebo over a 14-day period.71. in terms of incidence of gastrointestinal adverse events and headache. Pre-treatment MIC90 values for rifaximin against enterococci in all groups were 8–64 µg/mL and these did not change at day 3. placebo. 68 h with placebo (P = 0.s. (n = 199) Ciprofloxacin 500 mg b. A post hoc analysis of pooled data from the previous two studies was performed to assess the efficacy of rifaximin 200 mg t. Adverse events (%) with rifaximin and ciprofloxacin a randomized.0 25. no specific adverse events associated with rifaximin therapy were highlighted. vs. double-blind. placebo against TD with no pathogens identifiable from stool samples.s.s.d. Median TLUS was significantly less for both rifaximin and ciprofloxacin vs.95–3.51.d.[31. stool samples were collected and investigated for antibacterial resistance. India or Peru received 3 days of treatment with rifaximin 200 mg t. Overall. flatulence. (n = 100) Placebo b. Median TLUS in this subgroup was 33 h with rifaximin vs. loperamide monotherapy. Safety and Tolerability of Rifaximin in the Management of TD In the 10 studies reviewed for this paper.35–4.com/viewarticle/721697_print than those receiving placebo (52 h. and also in those where a pathogen was not identified.001). Bacterial Resistance to Rifaximin in TD In the placebo-controlled trials evaluating the efficacy of rifaximin 200 mg t.09). constipation. ciprofloxacin 500 mg b. The efficacy of rifaximin monotherapy (200 mg t. 95% CI: 1. 41] In placebo-controlled studies. vomiting and nausea). double-blind. The number of rifaximin-resistant coliforms isolated was low at baseline (pre-treatment) and did not increase significantly at days 3 or 5.d.s.01). double-dummy study. placebo. rifaximin and placebo. The median MIC for rifaximin against ETEC in this study was 12. 41] Table 2.d. on their arrival in Mexico. a greater number of patients receiving combination therapy reported complete wellness compared with rifaximin monotherapy (odds ratio = 2. placebo in the subgroups of patients with diarrhoeagenic E.d. 38–46] When directly compared with ciprofloxacin in patients with TD.
JAMA 1999. 5: 349–60. rifaximin was 4. and impact of traveler's diarrhea in Jamaica. the published evidence suggests that rifaximin should be considered as an effective and well-tolerated option for the treatment of uncomplicated TD.0 1. Daniels NA. 48] It has demonstrated good potency in vitro against the most common non-invasive pathogenic bacteria responsible for TD. Steffen R. but these may be associated with systemic adverse effects. rifaximin monotherapy was associated with a lower incidence of abdominal pain/cramps.0 0.0 5. 181: 1491–5. Furthermore.0 2. Clin Infect Dis 2005. nausea and vomiting. In addition. 4.0 1. coli and in cases where no pathogen was identified. Lancet Infect Dis 2005. this indication needs to be evaluated in larger and more diverse populations. In conclusion. Rifaximin is a virtually non-absorbed oral antibacterial that achieves high concentrations within the intestine. In addition.0 1. the development of bacterial resistance and drug–drug interactions.0 When compared with loperamide monotherapy in individuals with TD. Discussion Travellers' diarrhoea is a common problem in many countries and can have a significant negative impact on an individual's wellbeing and activities.0 9. When administered t. 6.[26.0 2. 3. no data are currently available to support the efficacy and safety of rifaximin in individuals with TD who are aged <18 years. the studies conducted to date have focused primarily on individuals visiting Central and South America. J Infect Dis 2000. tenesmus. rifaximin is well tolerated by individuals with TD with a tolerability profile generally comparable with those of placebo and ciprofloxacin and minimal systemic side effects and a low potential for drug–drug interactions. the site of infection in TD. Traveler's diarrhea at sea: three outbreaks of waterborne enterotoxigenic Escherichia coli on cruise ships. Oral antibacterials are conventional therapy for TD (following anti-diarrhoeal agents and fluid replacement). Epidemiology. Steffen R.com/viewarticle/721697_print Headache Constipation Flatulence Rectal tenesmus Dizziness Vomiting Nausea 8. in terms of geographical travel destinations. 62: 585–9.d. Breeching NJ. rifaximin has demonstrated significantly superior efficacy to placebo or loperamide and comparable efficacy to a systemically absorbed antibacterial. Systematic review: the epidemiology and clinical features of travellers' diarrhea.0 4. Neimann J.0 1. Aliment Pharmacol 9 of 11 02-05-2011 19:55 .medscape. Another consideration is that a majority of clinical trials evaluating rifaximin completed to date have been performed by the same group of researchers. Further studies should therefore investigate the utility of rifaximin in TD in travellers to the Middle East. Asia and Africa. Nye FJ.0 2. 30–33] and its efficacy is therefore consistent across geographical locations. The odds ratio of vomiting for loperamide vs. 2. 281: 811–7. such as ciprofloxacin.e. DuPont HL. Traveller's diarrhea.0 2.0 2. et al. 50] There appear to be a number of gaps in the literature for rifaximin in TD.5 5.[34. 8): S536–40.41 (95% CI: 1. Epidemiology of traveler's diarrhea. in reducing the duration of illness. for 3 days.0 3. The evidence available suggests that the potential for bacterial resistance to rifaximin is low. i. 41(Suppl. 47. Al-Abri SS. Efficacy is also consistent across subgroups of individuals with diarrhoeagenic E. The results of these therefore need to be confirmed by other researchers.s. although the results from a single study suggest favourable efficacy of rifaximin in preventing TD.[49.Rifaximin for the Treatment of Travellers' Diarrhoea (printer-friendly) http://www. but is largely undetectable in the systemic circulation.0 1.28–15). Occurrence and self-treatment of diarrhea in a large cohort of Americans travelling to developing countries.0 1. rapidly restoring wellness in a majority of patients and therefore minimizing the interruption caused by TD. et al. References 1.0 2. Am J Trop Med Hyg 2000.0 2. Tornieporth N. Collard F. Hill DR. etiology. Notably. 5. Karpati A.0 8.
29. 43: 898–901. Jiang Z-D. Bustamante CI. Drug Saf 1999. Mathewson JJ. Sequelae of traveler's diarrhea: focus on postinfectious irritable bowel syndrome. 8. 8: 175–80. Ruiz J. et al. Travellers' diarrhea. Clin Infect Dis 2007. et al. Prevalence of enteric pathogens among international travellers with diarrhea acquired in Mombasa (Kenya). Lubezky A. Ericsson CD. Sambol SP. 31: 956–8. In vitro antimicrobial activity of rifaximin against enteropathogens causing traveler's diarrhea. Adachi JA. Schito GC. Prolonged diarrhea due to ciprofloxacin-resistant Campylobacter infection. 190: 1150–7. 13. Pang LW. Jiang Z-D. Antibiotic treatment for travellers' diarrhea. Galang MA. Adachi JA. 328: 1821–7. Carbon C. 41: S577–86. Antimicrob Agents Chemother 2001. Lubasch A. Osmolski JR. Vila J. trovafloxacin. Smith KE. Adachi JA. Abdalla S. Antimicrobial resistance among enteric pathogens. Rifaximin systemic absorption in patients with ulcerative colitis. 41: 93–8. Clin Infect Dis 2005. Tribble DR. Gascon J. 7. Semin Pediatr Infect Dis 2004. Mandell L. Comparison of side effects of levofloxacin versus other fluoroquinolones. Comparative antibiotic resistance of diarrheal pathogens from Vietnam and Thailand. 10. Clarke SC. Verenkar MP. Murray BE. 15. Rifaximin versus ciprofloxacin for the treatment of traveler's diarrhea: a randomized. Prescrire Int 2008. et al. double-blind trial. et al. Hoge CW. Empirical antibiotic therapy for traveler's diarrhea. Diarrheagenic Escherichia coli– an emerging problem? Diagn Microbiol Infect Dis 2001. Cochrane Database Syst Rev 2000. Connor BA. In vitro antimicrobial susceptibility testing of bacterial enteropathogens causing traveler's diarrhea in four geographic regions. Navia MM. Ericsson CD. Antimicrob Agents Chemother 2007. DuPont HL. Plaisance KI. Gascon J. grepafloxacin. Ericsson CD. 33. 10 of 11 02-05-2011 19:55 . De LeoC. O'Callaghan C. Enteroaggregative Escherichia coli as a major etiologic agent in traveler's diarrhea in 3 regions of the world. Gomi H. 30: 187–96. 38: 2668–70. J Infect Dis 2004. Chemotherapy 2001. Emerg Infect Dis 2002. 45: 643–4. Braz J Infect Dis 2008. et al. 34. Sierra JM. Gales AC. gatifloxacin. India (Goa). Ruiz J. 3): 9–14. Clin Infect Dis 2000. DuPont HL. Potasman I. 35. The use of systemic fluoroquinolones. Stermer E. Antimicrob Agents Chemother 2000. Hecht DW. Vugia D. 23. 26. Johnson S. Ericsson CD. 185: 497–502. N Engl J Med 1993. Lavy A. Int J Antimicrob Agents 2003. Clin Infect Dis 2001. Koeppe P. Ball P. Dalla Costa LM. 12: 5–9. 16. 31: 1079–83. 21. Paster E. 32: 1706–9. Antimicrob Agents Chemother 1990. Effect of dose size on bioavailability of ciprofloxacin. Pediatrics 2006. 17: 20. Lowe B. Drusano GL. Tognim MCB. 1996–1999. Srijan A. 21: 407–21. Comparative pharmacokinetics of ciprofloxacin. Hahn S. Jiang Z-D. 20. Eftimiadi C. 31. Standiford HC. 30. Mathewson JJ. Committee on Infectious Diseases. Gionchetti P. Quinolone-resistant Escherichia coli. 24. 45: 212–6. double-blind trial comparing single-dose and 3-day azithromycin-based regimens with a 3-day levofloxacin regimen. Diagn Microbiol Infect Dis 2007. Lode H. Clin Infect Dis 2006. 22. Borner K. Vila J. Sanders JW.medscape. 118: 1287–92. Emergence of resistant fecal Escherichia coli in travellers not taking prophylactic antimicrobial agents. 44: 2600–3. Jiang Z-D. 25. Fluoroquinolones: psychiatric adverse effects. De Bruyn G. 54: 91–3. Mensa L. Rizzello F. Antimicrobial resistance of Shigella isolates causing traveler's diarrhea. Rapid disappearance from the intestinal tract of bacteria resistant to rifaximin.Rifaximin for the Treatment of Travellers' Diarrhoea (printer-friendly) http://www. Antimicrob Agents Chemother 1994. Ericsson CD. Forrest A. Keller I. 21: 116–24. 9. Venturi A. 33: 1807–15. Reves RR. 28. Niki Y. Ostrosky-Zeichner L. Clin Infect Dis 2001. 15: 71–7. J Infect Dis 2002. 14. 59: 473–5. In vitro activities of 15 antimicrobial agents against 110 toxigenic Clostridium difficile clinical isolates collected from 1983 to 2004. 17. DuPont HL. Borwick A. 18. Comparative tolerability of the newer fluoroquinolone antibacterials. 12. Vargas M. or Jamaica (Montego Bay). 47(Suppl. levofloxacin. 19. et al. et al. 11. Traveler's diarrhea in Thailand: randomized. Munerato P. Nelson JM. Tillotson G. Antimicrob Agents Chemother 2001. Is traveler's diarrhea a significant risk factor for the development of irritable bowel syndrome? A prospective study. 3: CD002242. Gerding DN. Sanches Ito CA. et al. Prevention and treatment of traveler's diarrhea. 27. 51: 2716–9. and moxifloxacin after single oral administration in healthy volunteers. Eur J Clin Pharmacol 1998. Isenbarger DW. Antimicrob Agents Chemother 1987. 34: 515–8. et al. DuPont HL. Pickering LK. 44: 338–46. In vitro activity of rifaximin against enteropathogens producing traveler's diarrhea. 32. Policy statement. et al.com/viewarticle/721697_print Ther 2009.
48. Forbes B. 41: 222–8. DuPont HL. Acknowledgements Declaration of personal interests: Professor Peter Layer has been a speaker and/or advisory board member for. students in Mexico. 101(Suppl. © 2010 Blackwell Publishing 11 of 11 02-05-2011 19:55 . Ericsson CD. DuPont HL. Pharmacokinetic study of rifaximin after oral administration in healthy volunteers. Rifaximin treatment of pathogen-negative traveler's diarrhea. In vitro activity of rifaximin. J Travel Med 2007. Steffen R. 74: 1060–6. et al. Pentikis H. Pharmacotherapy 2007. 36. 41. Ann Intern Med 2005. and/or recipient of unrestricted scientific grant by Esther-Christiansen-Foundation. Okhuysen PC. 43. Am J Gastroenterol 2003. et al. et al. Riopel L. Declaration of funding interests: Medical writing support was provided by M. Bourgeois AL. Am J Trop Med Hyg 2006. Haake R. Dubourg D. 38. DuPont HL. Palazzini E. 50. 5: 451–6. Falk Foundation. 47. Riopel L. Pentikis HS. Jiang Z-D. metronidazole and vancomycin against Clostridium difficile and the rate of selection of spontaneously resistant mutants against representative anaerobic and aerobic bacteria. rifaximin plus loperamide. Picard M. Braun Trapnell C. Aliment Pharmacol Ther 2008. Am J Gastroenterol 2006. including ammonia-producing species. Falk Foundation. A randomized. Jiang Z-D. 46. Norgine. Digestion 1998. Pesce A. Taylor DN.com/viewarticle/721697_print Drugs Exp Clin Res 1986. 2: 135–8. Clin Microbiol Infect 2004. Palazzini E. multicenter study of rifaximin compared with placebo and with ciprofloxacin in the treatment of traveler's diarrhea. Enteroaggregative Escherichia coli diarrhea in travelers: response to rifaximin therapy. Nycomed. 142: 805–12. Trapnell CB. double-blind. Influence of rifaximin treatment on the susceptibility of intestinal Gram-negative flora and enterococci. Axcan Pharma. Abbott Laboratories. Marchese A. Chemotherapy 2000. et al. Essex Pharma. 14: 16–9. Ann Pharmacother 2007. Forbes WP. 27: 741–51. Absence of effect of oral rifaximin on the pharmacokinetics or ethinyl estradiol/norgestimate in healthy females. Prevention of travelers' diarrhea with rifaximin – a phase 3 randomized double-blind placebo-controlled trial in U. and loperamide alone. Axcan Pharma. Systematic review: prevention of travellers' diarrhea. Blows (Euro RSCG Life Medicom) and funded by Norgine.Rifaximin for the Treatment of Travellers' Diarrhoea (printer-friendly) http://www. et al. Jiang Z-D. 2): S197. Bettenhausen DK. Jiang ZD. de la Cabada FJ. Antimicrob Agents Chemother 2000. Mathewson JJ. 37. 49. Connolly M. 39. DuPont HL. A randomized. Descombe JJ. 98: 1073–8. double-blind. Belkind-Gerson J. Bettenhausen DK. Clin Gastroenterol Hepatol 2007. DuPont HL. Therapy of travelers' diarrhea with rifaximin on various continents. 59: 708–14. Pfizer and Solvay. The effect of multiple-dose. 44. Debbia EA. et al. DuPont HL. Salerno A. Treatment of traveler's diarrhea: randomized trial comparing rifaximin. Taylor DN. Ericsson CD. 46: 253–66. Alimentary Pharmacology & Therapeutics. Connolly M. Jiang Z-D. Preston and S.31(11):1155-1164. placebo-controlled trial of rifaximin to prevent traveler's diarrhea.S. Roche and Solvay. et al. Schito GC. oral rifaximin on the pharmacokinetics of intravenous and oral midazolam in healthy volunteers. 2010. Ericsson CD. Norgine. Int J Clin Pharm Res 1994. et al. Sack DA. Clin Gastroenterol Hepatol 2004. In vitro activity and fecal concentration of rifaximin after oral administration. Ke S. 40. 45. 27: 1361–9. 12: 979–81. Infante RM. Ericsson CD.medscape. DuPont H. Dr Viola Andresen has been a speaker and/or advisory board member for Astra Zeneca. 10: 1009–11. 42. Rifaximin: a nonabsorbed antimicrobial in the therapy of traveler's diarrhea. DuPont HL. 14: 51–6. 44: 2205–6.
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