Review article: Rifaximin, a minimally absorbed oral antibacterial for the treatment of travellers' diarrhoea

Peter Layer (1) , Viola Andresen (1)

1 Israelitic Hospital

Background Travellers' diarrhoea (TD), 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 clinical evidence supporting the efficacy and safety of the minimally absorbed oral antibiotic rifaximin in TD. 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 publications. Results A total of 10 publications were identified. When administered three times daily for 3 days, rifaximin is superior to placebo or loperamide and at least as effective as ciprofloxacin in reducing duration of illness and restoring wellbeing in patients with TD, both with and without identification of a pathogen, as well as in Escherichia coli infection causing diarrhoea. 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. Conclusions When antibiotic therapy is warranted in uncomplicated TD, rifaximin may be considered as a first-line treatment option due to its favourable efficacy, tolerability and safety profiles.

Mots clés: Medicine

Peter Layer, Viola Andresen. Review article: Rifaximin, a minimally absorbed oral antibacterial for the treatment of travellers' diarrhoea. Alimentary Pharmacology and Therapeutics, 2010, 31 (11), pp.1155. ⟨10.1111/j.1365-2036.2010.04296.x⟩. ⟨hal-00552547⟩