Rifaximin versus Other Antibiotics in the Primary Treatment and Retreatment of Bacterial Overgrowth in IBS
Previous studies demonstrate improvement in IBS after antibiotic therapy, with the greatest efficacy seen with the antibiotic, rifaximin. The purpose of this study was to compare the efficacy of rifaximin in both the treatment and retreatment of IBS.
A retrospective chart review was conducted on Rome I-positive IBS patients. Charts were reviewed to evaluate all antibiotic treatments (rifaximin, neomycin, doxycycline, amoxicillin/clavulanate, and ciprofloxacin), even those predating 1 July 2004. Data collection included symptoms, breath test results (pre- and post-treatment), antibiotics used, and clinical response to individual antibiotic treatments before and after rifaximin availability in the USA.
Out of 98 eligible charts, 84 patients received one course of rifaximin. Fifty of these (60%) had a follow-up breath test. Among these, 31 (62%) were clinical responders and 19 (38%) were nonresponders. Of 31 responders, 25 (81%) had a normal follow-up breath test compared with only 3 of the 19 nonresponders (16%) (P < 0.001). Of participants given rifaximin, 69% (58 out of 84) had a clinical response compared with only 38% (9 out of 24) with neomycin (P < 0.01) and 44% (27 out of 61) with all non-rifaximin antibiotics (P < 0.01). Rifaximin was used as retreatment on 16 occasions, and all patients improved.
Rifaximin is more effective than other antibiotics in the treatment and retreatment of IBS.
KeywordsRifaximin Irritable bowel syndrome Small intestinal bacterial overgrowth Lactulose breath test
- 1.Drossman DA (1994) The functional gastrointestinal disorders: diagnosis, pathophysiology, and treatment. A multinational consensus. Little, Brown, BostonGoogle Scholar
- 5.Grundy D (2000) Mechanisms for the symptoms of irritable bowel disease—possible role of vagal afferents. In: Krammer H-J, Singer MV (eds) Neurogastroenterology from the basics to the clinics. Kluwer, Boston, pp 659–663Google Scholar
- 8.Thompson WG, Longstreth GF, Drossman DA et al (1999) Functional bowel disorders and functional abdominal pain. Rome II: a multinational consensus document on functional gastrointestinal disorders. Gut 45:1143–1147Google Scholar
- 14.McCallum R, Schultz C, Sostarich S (2005) Evaluating the role of small intestinal bacterial overgrowth (SIBO) in diarrhea predominant irritable bowel syndrome (IBS-D) patients utilizing the glucose breath test (GBT). Gastroenterology 128:A460Google Scholar
- 15.Posserud I, Stotzer PO, Einar S et al (2006) Altered counts of small bowel bacteria in patients with irritable bowel syndrome. Gastroenterol 130:A739Google Scholar
- 30.Mas A, Rodes J, Sunyer L et al (2003) Spanish association for the study of liver hepatic encephalopathy cooperative group. Comparison of rifaximin and lactitol in the treatment of acute hepatic encephalopathy: results of a randomized, double-blind, double dummy, controlled clinical trial. J Hepatol 38:51–58PubMedCrossRefGoogle Scholar
- 32.DuPont HL (2003) Community-acquired diarrheal disease in western countries: application of nonabsorbable oral antibiotic therapy. Adv Stud Med 3:S945–S950Google Scholar