Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Therap Adv Gastroenterol. 2011 Jul;4(4):227-35. doi: 10.1177/1756283X11398734.
Rifaximin is a nonabsorbable rifamycin derivative with an excellent safety profile and a broad spectrum of antimicrobial activity against a variety of enteropathogens causing acute infectious diarrhea. After oral ingestion, its bioavailability is known to be less than 0.4%, and it has a low potential for significant drug interactions. In the treatment of travelers' diarrhea caused by noninvasive diarrheagenic Escherichia coli, it has been demonstrated that rifaximin significantly shortens the duration of diarrhea and has an efficacy similar to that of ciprofloxacin. Moreover, according to two randomized placebo-controlled trials, prophylactic treatment with rifaximin reduced the risk of developing travelers' diarrhea by more than 50% compared with the placebo group. For the treatment of acute diarrhea unrelated to travel, a short course of rifaximin significantly reduced the duration of diarrhea, and its overall efficacy was comparable to that of ciprofloxacin. The discrepancy between the in vitro and in vivoantimicrobial activities of rifaximin, however, and the clinical implication of the rapid appearance of bacterial resistance, must be further elucidated. In conclusion, this gut-selective antibiotic seems to be a promising option for the treatment of acute infectious diarrhea secondary to noninvasive E. coli and also appears to be effective in chemoprophylaxis for travelers' diarrhea.
利福昔明是一种不可吸收的利福霉素衍生物，具有极好的安全性和广谱的抗菌活性，可对抗多种引起急性感染性腹泻的肠道病原体。口服后，其生物利用度已知小于 0.4%，并且具有发生显著药物相互作用的低潜力。在治疗由非侵袭性产肠毒性大肠杆菌引起的旅行者腹泻方面，已证明利福昔明可显著缩短腹泻持续时间，其疗效与环丙沙星相似。此外，根据两项随机安慰剂对照试验，与安慰剂组相比，利福昔明预防性治疗可使旅行者腹泻的发病风险降低 50%以上。对于与旅行无关的急性腹泻，利福昔明短疗程可显著缩短腹泻持续时间，其总体疗效与环丙沙星相当。然而，利福昔明的体外和体内抗菌活性之间的差异，以及细菌耐药性迅速出现的临床意义，仍需进一步阐明。总之，这种肠道选择性抗生素似乎是治疗非侵袭性大肠杆菌引起的急性感染性腹泻的一种有前途的选择，并且在旅行者腹泻的化学预防方面似乎也有效。
