Aims With the improved fitness and conditioning of athletes, the most common reason to miss training or competition, whilst abroad, is illness; especially Traveller's diarrhoea (TD) with an athlete potentially unable to compete for up to 3 days and after that not performing at optimum level for several more days.⇓

Methods Approaches to reduce TD include selecting clean food and bottled drinks, probiotics and Bovine colostrum. The fluroquinolones (Ciprofloxacin) have been the most effective both for prophylaxis and treatment of TD.1 ,2 However, in the athletic population there is a theoretical risk of tendon rupture with this class of drug. Therefore only non-athletes have used Ciprofloxacin as prophylaxis. Rifaxamin has poor bioavailability and is therefore poorly systemically absorbed thus acting locally in the intestine. As such, it has few side effects and a very low risk of tendon rupture due to its non-systemic absorption. There has only been one (very small) previous study on the use of Rifaxamin for TD.3

Historically, there has been a high incidence of TD in Hockey athletes when travelling to countries such as India, South Africa and Malaysia, not only from food but unclean water in the showers and on the pitch, on which they can dive and thus at risk of ingesting dirty water. Therefore Rifaxamin was trialled as TD prophylaxis as shown below:

Conclusions The results show that the introduction of prophylactic Rifaxamin has produced a significant reduction in the number of cases of TD. Oral Rifaxamin is now routinely offered (and accepted) by Hockey teams travelling to countries with high risk of TD and the incidence has reduced to almost negligible levels, thus ensuring athletes, and staff, are available for training and matches more often. After 18 months, there have been no cases of tendon rupture, which has been the worry when taking oral Ciprofloxacin.