This E-lettter is in response to Setting standards for the prevention and management of travellers’ diarrhoea in elite athletes: an audit of one team during the Youth Commonwealth Games in India Abstract | Full Article

The article by Tillett and Loosemore describes guidelines for the prevention and management of travellers’ diarrhoea (TD) based on their experience with the elite athletes and noncompeting members of Team England during the 2008 Youth Commonwealth Games in India. The authors recommended that all team members receive oral and written advice regarding prevention of TD, that all team members are issued alcohol hand gel and instruction for its use, and that all noncompeting team members receive ciprofloxacin for TD prophylaxis. As ciprofloxacin use in elite athletes is considered controversial because of a possible association with tendon rupture, the authors recommended that elite athletes consider the nonabsorbable antibiotic rifaximin as a prophylactic for TD. However, none of the elite athletes on Team England actually received rifaximin as a prophylactic therapy for TD. Further, the authors stopped short of recommending rifaximin for the treatment of TD, simply recommending treatment with empiric antibiotics per local advice and the results of stool culture.

We report here that, in 2008, some elite athletes from the United States received rifaximin either for the prophylaxis or treatment of TD while in Beijing, China. In this small sample of elite athletes, rifaximin was safe and well tolerated, and no adverse events were reported. Rifaximin has been found safe, well tolerated, and effective for both the prophylaxis and treatment of TD in other populations1-8. Based on our experience and the excellent safety profile of rifaximin for the treatment of TD, the use of rifaximin as an antibiotic therapy for the treatment of TD in elite athletes deserves further consideration.

Bradley Connor and Scott Rodeo

References

1.           DuPont HL, Ericsson CD, de la Cabada FJ, et al. Prevention of travelers’ diarrhea with rifaximin- a phase 3 randomized double-blind placebo-controlled trial in U.S. students in Mexico [abstract]. Am J Gastroenterol. 2006;101(suppl):S197-S198.

2.           DuPont HL, Ericsson CD, Mathewson JJ, et al. Rifaximin: a nonabsorbed antimicrobial in the therapy of travelers’ diarrhea. Digestion. 1998;59(6):708-714.

3.           DuPont HL, Haake R, Taylor DN, et al. Rifaximin treatment of pathogen- negative travelers’ diarrhea. J Travel Med. 2007;14:16-19.

4.           DuPont HL, Jiang ZD, Ericsson CD, et al. Rifaximin versus ciprofloxacin for the treatment of traveler’s diarrhea: a randomized, double-blind clinical trial. Clin Infect Dis. 2001;33(11):1807-1815.

5.           DuPont HL, Jiang Z-D, Belkind-Gerson J, et al. Treatment of travelers’ diarrhea: randomized trial comparing rifaximin, rifaximin plus loperamide, and loperamide alone. Clin Gastroenterol Hepatol. 2007;5:451-456.

6.           DuPont HL, Jiang Z-D, Okhuysen PC, et al. A randomized, double-blind,
placebo-controlled trial of rifaximin to prevent travelers’ diarrhea.
Ann
Intern Med. 2005;142(10):805-812.

7.           Steffen R, Sack DA, Riopel L, et al. Therapy of travelers’ diarrhea with rifaximin on various continents. Am J Gastroenterol. 2003;98:1073- 1078.

8.           Taylor DN, Bourgeois AL, Ericsson CD, et al. A randomized, double- blind, multicenter study of rifaximin compared with placebo and with ciprofloxacin in the treatment of travelers’ diarrhea. Am J Trop Med Hyg. 2006;74:1060-1066.

Conflict of Interest

Dr Connor has received grant support from and is a consultant for Salix Pharmaceuticals, Inc.
Dr Rodeo has nothing to disclose.