M. Riddle, B. Connor, D. Tribble
Nov 1, 2014
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0
Influential Citations
5
Citations
Quality indicators
Journal
Journal of travel medicine
Abstract
In this edition of the Journal of Travel Medicine , DuPont and colleagues report the results of a well‐conducted phase 3 randomized double‐blind placebo‐controlled trial evaluating a non‐absorbable antibiotic, Rifamycin SV, formulated with an enteric coating and a patented multimatrix (MMX®) technology that targets the delivery of the antibiotic to the distal small bowel and colon.1 Given the constancy of emerging antibiotic resistance to global bacterial enteropathogens, potential safety issues with systemic antibiotics, and the noble goal of targeted and measured antibiotic therapy, the need for novel antibiotics in travelers' diarrhea (TD) management has been identified.2 However, considering the observed and potential impact of TD on individual and population health and the global economy,3 effectiveness against a broad range of pathogens and syndromic presentations is a principal criterion on which novel antibiotic therapies are evaluated. Currently used antibiotics for the treatment of TD include systemically absorbed fluoroquinolones and azithromycin, and the non‐absorbable rifaximin. The study that is being reported by DuPont and colleagues is the first to evaluate a new non‐absorbable, Rifamycin SV‐MMX, which falls in the same antibiotic drug class, ansamycins, but is differentiated from rifaximin in that it targets distal small intestine and colonic delivery, whereas rifaximin primarily targets the small intestine due to its selective bile solubility in the proximal small intestine.4 The primary cause of TD is bacteria, and among these, the diarrheagenic Escherichia coli (DEC) predominate. These types of E. coli are varied in both their pathogenesis and site of infection which can range from the small intestine to the colon.5 Other prevalent bacterial causes … Corresponding Author: Mark S. Riddle, MD, Enteric Diseases Department, Naval Medical Research Center, 503 Robert Grant Ave., Silver Spring, MD 20910, USA. E‐mail: mark.riddle{at}med.navy.mil