Rifaximin treatment of pathogen-negative travelers' diarrhea

Herbert L. DuPont, Robert Haake, David N. Taylor, Charles D. Ericsson, Zhi Dong Jiang, Pablo C. Okhuysen, Robert Steffen

Research output: Contribution to journalArticlepeer-review

31 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)16-19
Number of pages4
JournalJournal of travel medicine
Issue number1
StatePublished - Jan 2007
Externally publishedYes

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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