School of Pharmacy, University of Washington, Seattle, WA, USA.
Syst Rev. 2012 Aug 28;1:39. doi: 10.1186/2046-4053-1-39.
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.
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.
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.
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.
最近在安全有效的非吸收性抗生素利福昔明方面的进展以及将感染后肠易激综合征确定为常见后遗症，这都呼吁重新考虑使用抗生素进行旅行者腹泻（TD）的初级预防的价值。
使用随机效应模型和异质性评估，对评估利福昔明或氟喹诺酮类药物化学预防 TD 的有效性和安全性的随机、安慰剂对照、双盲研究进行了汇总。
纳入的 9 项研究（4 项利福昔明和 5 项氟喹诺酮类药物）汇总的相对风险估计值分别为 0.33（95%CI=0.24-0.45，I2=3.1%）和 0.12（95%CI=0.07-0.20，I2=0.0%）。抗生素组和安慰剂组的治疗中出现的不良事件发生率相似。
这项荟萃分析支持抗生素预防 TD 的有效性。但是，需要针对不同地理区域的旅行者进行预防继发性慢性健康结局的进一步研究，以及进行抗生素化学预防的正式风险效益分析。
