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Digestive Diseases and Sciences

, Volume 58, Issue 6, pp 1676–1682 | Cite as

The Effect of Rifaximin on Gut Flora and Staphylococcus Resistance

  • Mi-Sung Kim
  • Walter Morales
  • Andres Ardila Hani
  • Sharon Kim
  • Gene Kim
  • Stacy Weitsman
  • Christopher Chang
  • Mark PimentelEmail author
Original Article

Abstract

Aim

Rifaximin is a non-absorbed antibiotic relative of rifampicin. The location of effect and staphylococcal resistance are two recent potential concerns with rifaximin. In this study we evaluate the location of effect of rifaximin as well as the development of staphylococcal rifampicin resistance.

Methods

Rats were divided into three groups. Group 1 gavaged for 10 days with PBS, group 2 gavaged with rifaximin for 10 days, and group 3 gavaged with rifaximin for 10 days and housed for 30 days. In each group, stool was collected daily for quantitative culture of Staphylococcus spp. and coliforms. After euthanasia luminal bacterial counts were determined at multiple gut locations by qPCR. Rifampicin susceptibility was tested on Staphylococcus pre and post rifaximin.

Results

At baseline, rats had a median of 2.90 × 106 cfu/ml Staphylococcus spp. in stool. After 10 days of rifaximin, this dropped to 1.20 × 105 cfu/ml (P < 0.01). With coliform counts, rats had a median of 1.86 × 104 cfu/ml at baseline which dropped to 2.2 × 103 cfu/ml (P < 0.01) after rifaximin. After cessation of rifaximin, coliform counts recovered within 3 days. When examining the total bacterial counts by qPCR, rifaximin reduced small bowel bacterial levels, but not colon. This reduction was sustained for 30 days. No colonies of Staphylococcus became resistant and only one colony was intermediate. The mean inhibitory concentration for rifampicin was not different before and after rifaximin.

Conclusion

Staphylococcal spp. fail to demonstrate resistance to rifampicin after rifaximin. The transient reductions in stool coliform counts recover while rifaximin appears to produce durable reductions in duodenal bacteria.

Keywords

Rifaximin Staphylococcus Coliforms 

Notes

Acknowledgments

This investigator-initiated study was supported by a grant from Salix Pharmaceuticals. In addition, this work was further supported by a grant from the Beatrice and Samuel A. Seaver Foundation.

Conflict of interest

Cedars-Sinai has a licensing agreement with Salix Pharmaceuticals. In additions, Drs. Pimentel and Chang are consultants for Salix Pharmaceuticals.

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Mi-Sung Kim
    • 1
  • Walter Morales
    • 2
  • Andres Ardila Hani
    • 2
  • Sharon Kim
    • 2
  • Gene Kim
    • 2
  • Stacy Weitsman
    • 2
  • Christopher Chang
    • 2
  • Mark Pimentel
    • 2
    Email author
  1. 1.Division of GastroenterologyCheongju St. Mary’s HospitalCheongjuKorea
  2. 2.GI Motility Program, Division of GastroenterologyCedars-Sinai Medical CenterLos AngelesUSA

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