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The study by Steffen1 was not available for review by the panel who recently published guidelines on travellers’ diarrhoea (TD).2 Steffen is careful in his concluding sentence to say that ‘Rifamycin may be considered as a first line treatment for afebrile, non-dysenteric TD’. Can the authors describe more precisely how they would prescribe Rifamycin? Should it be the sole antibiotic prescribed or should azithromycin also be prescribed in the event the traveller has infection with an invasive pathogen?

The FDA-approved use of rifaximin, a similar compound, was to treat TD when invasive pathogens were not present based largely on a study by Taylor.3 The hope with Rifamycin was that invasive pathogens might be better treated compared to rifaximin. However, potentially invasive pathogens were better treated by ciprofloxacin, and the median duration of diarrhoea of Rifamycin-treated potentially invasive pathogens (56.2 h) was similar to the median duration of diarrhoea in the placebo-treated arm of invasive pathogens in the Taylor study (58.3 h). While comparisons across studies are hazardous, the weight of the evidence calls into question the ability of Rifamycin to successfully treat invasive pathogens.

Issue Section:
Correspondence
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