Rifaximin treatment of pathogen-negative travelers' diarrhea
Rifaximin treatment of pathogen-negative travelers' diarrhea
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DOI：
10.1111/j.1708-8305.2006.00084.x
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发表时间：
2007-01-01
影响因子：
25.7
通讯作者：
Steffen, Robert
中科院分区：
文献类型：
--
作者：
DuPont, Herbert L.;Haake, Robert;Steffen, Robert
背景。抗菌药物似乎对缩短大多数旅行者腹泻病例的病程有效。这是来自两项随机、双盲、安慰剂对照试验的亚分析，研究对象是患有急性腹泻的成年旅行者，接受每日3次、200mg利福昔明治疗或安慰剂治疗3天。疗效通过从第一次给药开始到痊愈后排出最后一次未成形粪便的时间间隔来评估[最后未成形粪便时间（time to last unformed stool， TLUS）]；未成形粪便排出数；临床改善的百分比；和健康的发生率，结果322名随机分到利福昔明组和安慰剂组的患者中，有122名（38%）和230名（46%）在预处理样本中未发现粪便病原体。在病原体阴性的患者中，利福昔明在中位TLUS （33 vs 68 h, p < 0.005）、平均未成形便数（6.5 vs 8.6, p < 0.0001）和临床健康（77% vs 61%, p = 0.01）方面比安慰剂更有效。利福昔明与安慰剂的不良事件概况相似。超过三分之一的旅行者腹泻患者患有病原体阴性疾病。利福昔明治疗此病有效，无相关副作用。这些结果与未检测到的细菌性病原体是旅行者无明确原因腹泻的最可能原因的假设是一致的。
Background. Antibacterial drugs appear to be effective in shortening the illness of a majority of cases of travelers' diarrhea.Methods. This was a subanalysis from two randomized, double-blind, placebo-controlled trials in adult travelers with acute diarrhea treated with rifaximin 200 mg three times a day or placebo for 3 days. Efficacy was assessed by the interval beginning with the first dose of medication and ending with the last unformed stool passed after becoming well [time to last unformed stool (TLUS)]; number of unformed stools passed; percent with clinical improvement; and incidence of wellness achieved.Results. Stool pathogens were not identified in pretreatment samples in 122 of 322 (38%) patients and 106 of 230 (46%) randomized to rifaximin and placebo, respectively. Among pathogen-negative patients, rifaximin was more effective than placebo for median TLUS (33 vs 68 h, p < 0.005), mean number of unformed stools passed (6.5 vs 8.6, p < 0.0001), and clinical wellness (77% vs 61%, p = 0.01). The adverse-event profiles between rifaximin and placebo were similar.Conclusions. More than one third of patients with travelers' diarrhea had pathogen-negative illness. Rifaximin was effective in treating the illness without associated side effects. These results are consistent with the hypothesis that undetected bacterial pathogens are the most likely cause of travelers' diarrhea without definable cause.