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Mark S Riddle, Patrick Connor, David R Tribble, Antibiotics for Travellers’ Diarrhoea on Trial—is there a potential role for Rifamycin SV?, Journal of Travel Medicine, Volume 26, Issue 1, 2019, tay137, https://doi.org/10.1093/jtm/tay137
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Recently, in the Journal of Travel Medicine, Steffen et al. report the results of a well-conducted Phase 3 randomized double-blind placebo controlled trial evaluating a non-absorbable antibiotic, Rifamycin SV formulated with an enteric coating and a patented multimatrix (MMX®) technology which targets the delivery of the antibiotic to the distal small bowel and colon.1 Given the constancy of emerging bacterial enteropathogen antibiotic resistance, safety concerns with systemic antibiotics and appropriate antibiotic stewardship, there remains a continued need for novel TD antibiotic therapy.2 Novel therapy effectiveness, antibiotic and regimen (e.g. dosing, duration, adjunctive loperamide) should be considered relative to the current first-line therapies.
Currently used antibiotics for treatment of TD include systemically absorbed fluoroquinolones and azithromycin, and the non-absorbable rifaximin.3 The study reported by Steffen and colleagues herein is the second to evaluate a new non-absorbable, Rifamycin SV-MMX (RIF-MMX), which falls in the same antibiotic drug class (ansamycins) as rifaximin, but is differentiated in that it targets distal small intestine and colonic delivery, whereas rifaximin primarily targets the small intestine due to its decreased solubility in the colon.4 A recent study by Riddle et al. which reported results of a randomized controlled trial for acute watery diarrhoea among military travellers in Afghanistan, Djibouti, Honduras and Kenya has compared all three front-line antibiotics as single-dose therapy (in combination with loperamide).5 While conducted by different investigators, in different geographic regions and among different populations, these three recent studies in acute watery TD efficacy all used very similar eligibility criteria and outcome assessments, and thus provide the opportunity to make a meaningful comparison (Table 1).
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