Rifaximin could replace ciprofloxacin as first choice for traveler's diarrhea

WESTPORT, CT (Reuters Health) – An investigational antibiotic could be the next treatment of choice for traveler's diarrhea, according to a Texas researcher who recently conducted a study of the drug.

Rifaximin, a rifamycin derivative, is poorly absorbed, which would eliminate systemic side effects, said study director Dr. Herbert L. DuPont of St. Luke's Episcopal Hospital, in Houston.

The new findings have "great implications," Dr. DuPont, told Reuters Health. Because of the lack of systemic side effects, the drug should prove safe in all persons, including children, pregnant women and individuals with kidney failure. Rifaximin "would eliminate the need to use a quinolone" to treat traveler's diarrhea, and reduce the risk of quinolone resistance.

Dr. DuPont, and colleagues, evaluated the use of rifaximin to treat diarrhea in 187 adult students in the US and Mexico and international travelers in Jamaica. Ninety-three patients were randomized to rifaximin, 400 mg twice per day, and 94 were randomized to ciprofloxacin, 500 mg twice per day, for 3 days.

The two groups fared equally well in terms of the time from initiation of therapy to passage of last unformed stool, clinical improvement in 24 hours, failure to respond and microbiological cure, the researchers report in the December 1st issue of Clinical Infectious Diseases.

"The present study shows the equivalence of rifaximin and ciprofloxacin in the treatment of acute traveler's diarrhea," the authors summarize. Once rifaximin is approved, Dr. DuPont expects it to replace ciprofloxacin as the first-line treatment for this indication, and possibly other forms of dysentery. Ciprofloxacin could be saved for use for "more important infections," he added.

Further studies are now being conducted to assess rifaximin's efficacy in more invasive forms of diarrhea, such as shigella dysentery. The US Food and Drug Administration waiting for the results of these additional studies before approving rifaximin, Dr. DuPont told Reuters Health, but "things look good for this drug."

Clin Infect Dis 2001;33:1807-1815.

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