Prevention of Traveler's Diarrhea: A Call to Reconvene

Systematic review: prevention of travellers’ diarrhoea

“…Given the importance of diarrhoeagenic E. coli as causes of TD, rifaximin would still be of value, if not effective, in preventing invasive forms of enteric infection. Continued study of the occurrence of functional diarrhoea and other chronic gastrointestinal diseases 82 is needed with an emphasis on the beneficial effects of prophylactic drugs on reducing these complications 10 …”

“…When they made their recommendations, the panel was considering the absorbed antibacterial drugs, trimethoprim/sulfamethoxazole (TMP/SMX) and the fluoroquinolones. With the availability of non‐absorbed (<0.4%) rifaximin, over‐the‐counter bismuth subsalicylate (BSS) and probiotics with activity against prevalent bacterial enteropathogens and with the recent awareness of the occurrence of chronic gastrointestinal disease in those acquiring TD, the concept of chemoprophylaxis needs to be re‐examined 10 …”

In Vitro Activity and Single-Step Mutational Analysis of Rifamycin SV Tested against Enteropathogens Associated with Traveler's Diarrhea and Clostridium difficile

“…Coupled with the proprietary drug delivery system MMX (Cosmo Technologies Ltd., Dublin, Ireland), designed to release the antibiotic in the colonic lumen, rifamycin SV has been formulated as a tablet for treatment of colonic bacterial infections, including traveler's diarrhea (TD) and Clostridium difficile-associated disease (CDAD). As with all members of the rifamycin group, rifamycin SV inhibits DNA transcription by interfering with bacterial RNA polymerases (2,22).TD is the most common gastrointestinal (GI) illness contracted by persons from developed countries when they visit resource-poor countries; annually, it is estimated that 100 million persons travel internationally, with an estimated 30 to 40% of them developing TD and approximately 3% progressing to postinfectious irritable bowel syndrome (15,19). The most common bacterial etiologies of TD, accounting for nearly 60 to 80% of the cases, are pathogenic Escherichia coli, Salmonella spp., Shigella spp., and Campylobacter spp.…”

“…TD is the most common gastrointestinal (GI) illness contracted by persons from developed countries when they visit resource-poor countries; annually, it is estimated that 100 million persons travel internationally, with an estimated 30 to 40% of them developing TD and approximately 3% progressing to postinfectious irritable bowel syndrome (15,19). The most common bacterial etiologies of TD, accounting for nearly 60 to 80% of the cases, are pathogenic Escherichia coli, Salmonella spp., Shigella spp., and Campylobacter spp.…”

“…These guidelines recommend the use of a fluoroquinolone (FQ) or azithromycin for most travelers worldwide although regional pockets have significant levels of FQ-resistant (FQR) enteropathogens, especially in Southeast Asia and the Indian subcontinent. An alternative antimicrobial treatment option that is recommended for TD is rifaximin (12,15), a compound closely related to rifamycin SV (18). Rifaximin is available in several countries and has been approved in the United States for the treatment of nondysenteric TD caused by noninvasive strains of E. coli in patients of Ն12 years of age (13).…”