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Meta-Analysis
. 2012 Aug 28:1:39.
doi: 10.1186/2046-4053-1-39.

Effectiveness of rifaximin and fluoroquinolones in preventing travelers' diarrhea (TD): a systematic review and meta-analysis

Sanjin Alajbegovic  1 , John W Sanders, Deborah E Atherly, Mark S Riddle
Affiliations
Meta-Analysis

Effectiveness of rifaximin and fluoroquinolones in preventing travelers' diarrhea (TD): a systematic review and meta-analysis

Sanjin Alajbegovic et al. Syst Rev. .

Abstract

Background: Recent developments related to a safe and effective nonabsorbable antibiotic, rifaximin, and identification of postinfectious irritable bowel syndrome as a frequent sequela call for a need to reconsider the value of primary prevention of traveler's diarrhea (TD) with antibiotics.

Methods: Randomized, placebo-controlled, double-blind studies evaluating the effectiveness and safety of rifaximin or a fluoroquinolone chemoprophylaxis against TD were pooled using a random effects model and assessed for heterogeneity.

Results: The nine studies (four rifaximin and five fluoroquinolone) included resulted in pooled relative risk estimates of 0.33 (95% CI = 0.24-0.45, I2 = 3.1%) and 0.12 (95% CI = 0.07-0.20, I2 =0.0%), respectively. Similar rates of treatment emergent adverse events were found between antibiotic and placebo groups.

Conclusions: This meta-analysis supports the effectiveness of antibiotics in preventing TD. However, further studies that include prevention of secondary chronic health outcomes among travelers to different geographic regions, and a formal risk-benefit analysis for antibiotic chemoprophylaxis, are needed.

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Figures

Figure 1
Figure 1
Flow diagram of literature review, eligibility determination and inclusion in the systematic review and meta-analysis. RCT, randomized controlled trial.
Figure 2
Figure 2
Frequency distribution of assessment of bias scoring among included studies in meta-analysis ( n = 9).
Figure 3
Figure 3
Pooling of studies by drug class for intention to treat analysis. RR = relative risk; PE = protective efficacy; CI = confidence interval. 1. Regimen using ciprofloxacin. 2. Regimen using norfloxacin.
See this image and copyright information in PMC

References

    1. Shah N, DuPont HL, Ramsey DJ. Global etiology of travelers’ diarrhea: systematic review from 1973 to the present. Am J Trop Med Hyg. 2009;80:609–614. - PubMed
    1. Riddle MS, Halvorson HA, Shiau D, Althoff J, Monteville MR, Shaheen H, Horvath EP, Armstrong AW. Acute gastrointestinal infection, respiratory illness, and noncombat injury among US military personnel during Operation Bright Star 2005, in Northern Egypt. J Travel Med. 2007;14:392–401. doi: 10.1111/j.1708-8305.2007.00159.x. - DOI - PubMed
    1. Shlim DR. Looking for evidence that personal hygiene precautions prevent traveler’s diarrhea. Clin Infect Dis. 2005;41(Suppl 8):S531–S535. - PubMed
    1. Heywood AE, Zhang M, MacIntyre CR, Seale H. Travel risk behaviours and uptake of pre-travel health preventions by university students in Australia. BMC Infect Dis. 2012;12:43. doi: 10.1186/1471-2334-12-43. - DOI - PMC - PubMed
    1. Yanni EA, Marano N, Han P, Edelson PJ, Blumensaadt S, Becker M, Dwyer S, Crocker K, Daley T, Davis X, Gallagher N, Balaban V, McCarron M, Mounts A, Lipman H, Brown C, Kozarsky P. Knowledge, attitudes, and practices of US travelers to Asia regarding seasonal influenza and H5N1 avian influenza prevention measures. J Travel Med. 2010;17:374–381. doi: 10.1111/j.1708-8305.2010.00458.x. - DOI - PubMed

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