In vitro activity of rifaximin against bacterial enteropathogens causing diarrhoea in children under 5 years of age in Ifakara, Tanzania

Sir, Among the bacterial pathogens associated with the development of diarrhoea in children in developing areas, some pathogenic strains of Escherichia coli and Shigella spp. are especially important, because of both the frequency with which they are isolated and the severity of the symptoms they produce.1,2 In developing countries it is common to treat infections empirically. Therefore, knowledge of the local bacterial resistance pattern is a valuable weapon for clinicians in these areas. In Ifakara, as well as in other developing areas, the usual therapy for severe diarrhoea in children is oral rehydration plus an antibiotic, currently co-trimoxazole. In previous studies carried out in Ifakara, in which the resistance levels of 130 pathogenic E. coli and 86 Shigella spp. were analysed, high rates of resistance, amounting to 100% in some cases, to ampicillin, chloramphenicol, tetracycline and co-trimoxazole were found in the microorganisms studied.1,2 Only quinolones and cephalosporins retained a good activity.1,2 However, neither is a viable alternative because of their high price. Furthermore, quinolones are not recommended for paediatric use.