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Antibiotic May Stop Traveler's Diarrhea

Rifaximin Approved to Treat Traveler's Diarrhea Caused by E. coli Bacteria
By
WebMD Health News

May 16, 2005 -- An antibiotic called rifaximin may help prevent traveler's diarrhearifaximin may help prevent traveler's diarrhea caused by E. coli bacteria, according to a new study.

That may be particularly helpful in Mexico, where E. coli accounts for most cases of traveler's diarrhea, say the researchers in the Annals of Internal Medicine.

However, rifaximin hasn't been proven to treat traveler's diarrhea that is not caused by E. coli, and it didn't completely prevent the problem, in the study by Herbert DuPont, MD, and colleagues.

Traveler's diarrhea is the most common illness affecting travelers, says the CDC. Diarrhea strikes 20%-50% of international travelers (an estimated 10 million people) every year.

Diarrhea Prevention Test

The FDA approved rifaximin last summer to treat traveler's diarrhea caused by E. coli. DuPont's team tested the antibiotic on American students who were new in Mexico and had not yet developed traveler's diarrhea.

DuPont's study included 210 healthy adults who were taking summer classes and living with local families in Guadalajara, Mexico. The students got instruction on avoiding traveler's diarrhea, including safe food selection. They ate most of their meals in local homes with local families; however, the researchers expected similar rates of diarrhea as if their meals were consumed in public restaurants.

They also took rifaximin or a placebo during their first two weeks in Mexico; they didn't know which pills they had received.

Participants were followed for three weeks to see if diarrhea developed and for two more weeks to track side effects. While the students took their treatment, changes in the normal bacteria of the gut were tracked. Antibiotic treatment changes the normal gut environment and can lead to antibiotic-resistant bacteria.

Fewer Diarrhea Cases With Rifaximin

The rifaximin group had fewer cases of diarrhea during their first two weeks in Mexico. Of the students taking rifaximin, nearly 15% developed diarrhea compared with more than half of the students that took the placebo.

Rifaximin provided 72% protection against traveler's diarrhea. All rifaximin doses fared better than the placebo, the study shows.

The rifaximin group also got protection from milder diarrhea and moderate-to-severe intestinal symptoms such as pain, cramps, and excessive gas. Minimal effects were seen on intestinal flora.

Rifaximin and the placebo had comparable rates of side effects (such as headache and sore throat), write researchers.

The Right Strategy?

Rifaximin appears to be an "ideal drug" for preventing bacterial diarrhea "and should be safe even for prolonged use in at-risk international travelers," writes DuPont, who works at the University of Texas Health Science Center at Houston.

However, a journal editorial questions the appropriateness of prescribing an antibiotic to millions of travelers every year.

"Rapid and judicious treatment of diarrhea, not antibiotic prophylaxis, is the best recommendation for most travelers," writes Sherwood Gorbach, MD, of Tufts University's medical school.

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