Rifaximin ( Normix, Xifaxan ) has been used successfully for the prevention of travelers' diarrhea ( TD ), the most general cause of disability among international travelers to developing tropical and semitropical regions.
Researchers sought to better evaluate the efficacy of Rifaximin in the prevention of travelers' diarrhea. Randomized controlled trials ( RCTs ) of Rifaximin for the prevention of travelers' diarrhea published in literature were searched.
The primary efficacy outcome was occurrence of travelers' diarrhea over a 2-week treatment period. Secondary outcomes were requirement for antibiotic treatment, occurrence of mild diarrhea (MD), occurrence of travelers' diarrhea in the third week after drug withdrawal, incidence of travelers' diarrhea associated with isolation of diarrheagenic Escherichia coli and adverse events.
Four RCTs with 502 participants were included in the systematic review. Rifaximin treatment showed a significant protection against travelers' diarrhea ( risk ratios, RR=0.41; p less than 0.00001 ) and needed antibiotic-treated travelers' diarrhea ( relative risk [ RR ]: 0.30; p less than 0.00001 ).
There was no significant difference between Rifaximin and placebo in the occurrence of mild diarrhea ( RR: 1.11; p=0.55 ) and the occurrence of travelers' diarrhea in the third week after drug withdrawal ( RR: 0.73; p=0.47 ).
Enterotoxigenic Escherichia coli was the major cause of travelers' diarrhea, and all trials reported no differences in adverse events between Rifaximin and placebo.
In conclusion, Rifaximin can prevent travelers' diarrhea caused by non-invasive enteric pathogens. Further research is needed for the treatment of invasive enteric pathogens. ( Xagena )
Hu Y et al, J Travel Med 2012;19: 352-356