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

Sanjin Alajbegovic1, John W Sanders2, Deborah E Atherly3 and Mark S Riddle2*

Author Affiliations

1 School of Pharmacy, University of Washington, Seattle, WA, USA

2 Naval Medical Research Center, Silver Spring, 20910-7500, MD, USA

3 PATH, Seattle, WA, USA

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Systematic Reviews 2012, 1:39  doi:10.1186/2046-4053-1-39

Published: 28 August 2012



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.


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.


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.


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.

Travelers’ diarrhea; Chemoprophylaxis; Systematic review; Meta-analysis; Rifaximin; Fluoroquinolone