CRD Summary: This review found that adding loperamide to antibiotic therapy for the treatment of traveller's diarrhoea reduced illness duration and increased the probability of early clinical cure. The review included small, low-quality trials that were mostly conducted in Mexico. Limitations mean that the reliability and generalisability of the authors' conclusions are uncertain.

CRD Commentary: The review question was clear and inclusion criteria were clearly defined. The search strategy covered many sources, but as the search terms used were not given in the review the comprehensiveness of the search could not be assessed. As only studies published in English were included, there was a potential for language bias. The authors did not assess publication bias because of the small number of included trials. Appropriate attempts were made to reduce error and bias in the selection of studies, validity assessment and data extraction. The quality of the included trials was generally low, but the authors did not give sufficient data from the included studies for the reader to know what aspect of the trial methodology was poor. It appeared that three included studies did not meet the inclusion criteria, although these were not included in the main meta-analysis. One study included in the meta-analysis did not report all required outcomes. Due to the small range of countries in which the studies were set, it was questionable whether the results were generalisable to all cases of traveller's diarrhoea. The limitations mean that the reliability of the authors' conclusions is uncertain.