Original Paper

Rifaximin: A Nonabsorbed Antimicrobial in the Therapy of Travelers' Diarrhea
H.L. DuPont^a,b, C.D. Ericsson^b, J.J. Mathewson^b, E. Palazzini^c, M.W. DuPont^b, Z.D. Jiang^b, A. Mosavi^b, F.J. de la Cabada<sup>d

a</sup> St. Luke's Episcopal Hospital, and
^b University of Texas-Houston, Tex., USA;
^c Alfa Wassermann, Bologna, Italy, and
^d Hospital General de Occidente, Guadalajara, Mexico

Address of Corresponding Author

Digestion 1998;59:708-714 (DOI: 10.1159/000007580)

  Key Words

• Rifaximin
• Diarrhea
• Travelers

  Abstract

Background/Aims: Bacterial enteropathogens, the major cause of travelers' diarrhea, are customarily treated with antibacterial drugs. Rifaximin, a nonabsorbed antimicrobial was examined as treatment for travelers' diarrhea. Methods: A randomized, prospective, double-blind clinical trial was carried out in 72 US adults in Mexico. Patients with acute diarrhea received one of three doses of rifaximin (200, 400 and 600 mg t.i.d.) or trimethoprim/sulfamethoxazole (TMP/SMX, 160 mg/800 mg b.i.d.) for 5 days. Results were compared with data from 2 placebo-treated historical control populations. Results: The shortest duration of treated diarrhea was seen in the group receiving 200 mg rifaximin t.i.d (NS). Clinical failure to respond to treatment occurred in 6 of 55 (11%) rifaximin-treated subjects versus 5 of 17 (29%) of TMP/SMX-treated subjects (NS). Sixteen of twenty (80%) of the enteropathogens isolated from the rifaximin-treated subjects and 7 of 7 (100%) from the TMP/SMX group were eradicated by treatment (NS). Sixteen of twenty-four (67%) enteropathogens identified were susceptible to TMP and all 24 were inhibited by 50 µg/ml of rifaximin. Rifaximin reduced the number of unformed stools passed during the first 24 h of treatment when compared with 2 control placebo groups (3.3 versus 5.1; p = 0.008 and 0.0001) and led to a reduced duration of post-enrollment diarrhea (mean values of 43.1 versus 68.1 and 81.9 h; p = 0.001). Conclusions: Rifaximin shortened the duration of travelers' diarrhea compared with TMP/SMX and 2 earlier studied placebo-treated groups. A poorly absorbed drug if effective in treating bacterial diarrhea has pharmacologic and safety advantages over the existing drugs.

  Author Contacts

Herbert L. DuPont, MD
St. Luke's Episcopal Hospital
6720 Bertner Ave., MC 1-164
Houston, TX 77030 (USA)
Tel +1 713 791 4122, Fax +1 713 791 4167, E-Mail hdupont@sleh.com

  Article Information

Received: Received: December 15, 1997
Accepted: March 16, 1998
Number of Print Pages : 7
Number of Figures : 1, Number of Tables : 5, Number of References : 27