title: Effectiveness of rifaximin and fluoroquinolones in preventing travelers' diarrhea (TD): a systematic review and meta-analysis.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Pharmacy, University of Washington, Seattle, WA, USA.
authors.forename: Sanjin
authors.initials: S
authors.lastname: Alajbegovic
authors.forename: John W
authors.initials: JW
authors.lastname: Sanders
authors.forename: Deborah E
authors.initials: DE
authors.lastname: Atherly
authors.forename: Mark S
authors.initials: MS
authors.lastname: Riddle
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D003967:Diarrhea / Q000517:prevention & control*; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012294:Rifamycins / Q000627:therapeutic use*; D000078262:Rifaximin; D014195:Travel
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D024841:Fluoroquinolones; D012294:Rifamycins; D000078262:Rifaximin