Benefits of the Antibiotic Rifaximin as Empiric Therapy in... : Official journal of the American College of Gastroenterology | ACG (2023)



Barrett, George MD

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Gastroenterology/Internal Medicine, Milton Hospital, Milton, MA.

American Journal of Gastroenterology 101():p S479-S480, September 2006.

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Purpose: Irritable bowel syndrome (IBS) affects ∼58 million individuals in the United States, and data suggest a possible role for intestinal bacteria in the pathogenesis/clinical symptoms of IBS. Rifaximin (Xifaxan®, Salix Pharmaceuticals, Morrisville, NC) is a nonsystemic (<0.4% absorption), gut-selective, well-tolerated antibiotic with broad-spectrum activity against gram-positive and gram-negative aerobic and anaerobic organisms. Due to limited data available on potential benefits of rifaximin treatment in combination with probiotics in patients with IBS, a retrospective chart review was conducted from November 2004 to September 2005 to identify patients with IBS fulfilling Rome II criteria who were treated with rifaximin.

Methods: Eight patients were identified (21 to 73 years of age) with a history of IBS for >1 year. Patients were classified as IBS associated with diarrhea (n = 5) or IBS with alternating diarrhea and constipation (n = 3). Comorbidities included gastroesophageal reflux disease (n = 4), lactose intolerance/peptic ulcer (n = 1), pancreatitis (n = 1), Schatzki's ring (n = 1), and infection with human immunodeficiency virus (n = 1). Previous IBS therapy included probiotics (n = 3) or high-fiber diet (n = 1). Patients were empirically treated with rifaximin 400 mg 3 times daily for a mean of 2.5 months (range, 1 to 5 months) in combination with a probiotic (Flora-Q™, Kenwood Therapeutics, Fairfield, NJ) administered once- (n = 7) or twice-daily (n = 1).

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Results: Rifaximin use resulted in complete resolution of clinical symptoms in 4 patients, with no IBS relapse (follow-up, 1 to 6 months). Partial symptom improvement was observed in 4 patients, 3 of whom were treated for an additional 2 months with rifaximin 400 mg three times daily cycle therapy (2 weeks on/1 week off; with 1 patient also receiving a probiotic) which resulted in a 50% to 70% improvement from baseline. Rifaximin treatment was well tolerated, with no discontinuations or disruptions in the treatment regimen and no reports of rifaximin-related adverse events. All 8 patients remain on probiotic once daily maintenance therapy.

Conclusions: This chart review suggests that some patients with IBS may benefit from rifaximin and probiotic combination therapy. Given the low risk for clinical resistance and positive rifaximin attributes described above, further studies on the potential benefit of this nonsystemic antibiotic for IBS are warranted.

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What are the benefits of rifaximin? ›

Rifaximin is used to treat traveler's diarrhea that is caused by a bacteria called Escherichia coli. It is also used to prevent hepatic encephalopathy, which is a condition that occurs when your liver does not work normally. This medicine is also used to treat irritable bowel syndrome with diarrhea.

What are the reviews for rifaximin? ›

Rifaximin has an average rating of 6.5 out of 10 from a total of 105 reviews on 57% of reviewers reported a positive experience, while 33% reported a negative experience.

How is rifaximin different from other antibiotics? ›

Rifaximin is a broad-spectrum nonabsorbed rifamycin antibiotic with an excellent safety profile, a lack of drug interactions, and minimal effect on the intestinal microbiome. This gut-selective antimicrobial is currently approved for the treatment of travelers' diarrhea caused with noninvasive E. coli strains.

How effective is rifaximin for SIBO? ›

In one study37 SIBO positive patients were treated with rifaximin followed by a cycle of probiotics (Lactobacilli and Bifidobacteria based preparation) for twenty‐day. Follow‐up was performed 4–5 months after the end of treatment and revealed an eradication rate of 82.6% (95% CI: 61.2–95).

Does rifaximin wipe out good bacteria? ›

In those who receive several courses of Rifaximin, with each course more and more beneficial gut bacteria are wiped out - making room for more pathogenic bacteria to move in.

Does rifaximin help with inflammation? ›

Rifaximin reduced gut-derived systemic inflammation by suppressing oralisation of the gut microbiome. Rifaximin suppressed mucin-degrading species rich in sialidase, e.g. Streptococcus and Veillonella spp. Rifaximin promotes an intestinal environment augmenting responses to pathobionts and promoting gut barrier repair.

Can you take rifaximin long-term? ›

Rifaximin is safe and well tolerated for long-term maintenance of remission from overt hepatic encephalopathy.

Who should not take rifaximin? ›

Rifaximin should not be used if you have a fever or bloody diarrhea. It works by stopping the growth of bacteria. This antibiotic treats only bacterial infections. It will not work for viral infections (such as common cold, flu).

How long should a patient take rifaximin? ›

When rifaximin is used to treat traveler's diarrhea, it is usually taken three times a day for 3 days. When rifaximin is used to prevent episodes of hepatic encephalopathy, it is usually taken twice a day. When rifaximin is used to treat irritable bowel syndrome, it is usually taken three times a day for 14 days.

Should you take probiotics with rifaximin? ›

Conclusions: This chart review suggests that some patients with IBS may benefit from rifaximin and probiotic combination therapy. Given the low risk for clinical resistance and positive rifaximin attributes described above, further studies on the potential benefit of this nonsystemic antibiotic for IBS are warranted.

What foods to avoid while taking Xifaxan? ›

Notes for Consumers: Do not drink grapefruit juice or eat grapefruit while taking this medication. Grapefruit may alter the effects of your medication. Serious side effects may occur. Contact your care team right away if you experience new or worsening side effects.

Does rifaximin affect the immune system? ›

Studies have shown that rifaximin can suppress microbes-induced immune response through inhibiting the activation of NF-κB via the pregnane X receptor(Jin et al., 2017; Lopetuso et al., 2018). In our study, we focused on the TLR-4 which has been shown to play a key role in the many inflammatory diseases.

What type of SIBO does rifaximin treat? ›

Small intestinal bacterial overgrowth – In patients with small intestinal bacterial overgrowth, we use rifaximin (1650 mg per day for 14 days). Rifaximin is non-absorbable rifamycin derivative. It is well tolerated and has been demonstrated to be effective in the treatment of SIBO [2-8].

What foods make SIBO worse? ›

Foods you may want to consider eliminating from your diet that include higher amounts of FODMAPs include:
  • high-fructose corn syrup.
  • agave nectar.
  • honey.
  • soda and soft drinks.
  • garlic.
  • onions.
  • asparagus.
  • butternut squash.
Aug 16, 2018

What can I take instead of rifaximin for SIBO? ›

While Xifaxan is the most studied antibiotic for SIBO, there may be alternatives, such as metronidazole or ciprofloxacin.

Can you get rid of SIBO permanently? ›

SIBO can be cured in most people by treating the underlying cause and eradicating the bacterial overgrowth with one or two weeks of antibiotic therapy. The effectiveness of antibiotics, however, may be limited. In many cases, patients successfully treated with antibiotics will experience SIBO again within nine months.

What is the success rate of Xifaxan? ›

Xifaxan has anti-inflammatory action on the intestinal mucosa. Shorter treatment duration compared to herbal antimicrobials; similar to the elemental diet treatment duration. 70-85% success rate in normalizing the lactulose breath test.

What bacteria does rifaximin treat? ›

Abstract. Rifaximin is a non-systemic oral antibiotic derived from rifampin and characterized by a broad spectrum of antibacterial activity against Gram-positive and -negative, aerobic and anaerobic bacteria.

What does rifaximin do for IBS? ›

Rifaximin has activity against anaerobic, gram-positive, and gram-negative bacteria, including Clostridium difficile. It is not systemically absorbed and is active only in the gastrointestinal tract. It may work by reducing bacterial byproducts and altering intestinal microbiota.

How long before rifaximin works for SIBO? ›

Rifaximin is the most well-studied antibiotic for SIBO, with a success rate of about 50% after 1 week. A combination of rifaximin and other antibiotic, neomycin, has been shown to be around 85% effective after 10 days (14, 15).

Can rifaximin cure gastritis? ›

The data presented expand previous research, suggesting that rifaximin may be considered as monotherapy or combination therapy for a variety of enteric conditions, including Clostridium difficile-associated diarrhea, cryptosporidial diarrhea, Helicobacter pylori-associated gastritis, inflammatory bowel disease, ...

Who should not take Xifaxan? ›

You should not take rifaximin if you are allergic to rifaximin, rifabutin, rifampin, or rifapentine. Tell your doctor if you have ever had: liver disease; diarrhea with a fever; or.

Why does rifaximin cost so much? ›

There is currently no generic for Xifaxan (rifaximin), so it can be expensive, even with insurance. GoodRx coupons, copay cards and patient assistance programs may help lower the cost.

What can be taken instead of Xifaxan? ›

  • Lotronex.
  • Immune globulin oral.
  • EnteraGam.
  • Eluxadoline.
  • Viberzi.

What does Xifaxan do for your stomach? ›

This medication is used to treat diarrhea caused by the common bacteria known as E. coli ("traveler's diarrhea"). Rifaximin should not be used if you have a fever or bloody diarrhea. It works by stopping the growth of bacteria.

What happens when you stop taking Xifaxan? ›

Do not stop taking your medicine or lower the dosage without checking with your doctor. If you stop taking it suddenly, your condition may worsen or you may have unwanted side effects.

How long is it safe to take Xifaxan? ›

Dosage For Irritable Bowel Syndrome With Diarrhea

The recommended dose of XIFAXAN is one 550 mg tablet taken orally three times a day for 14 days. Patients who experience a recurrence of symptoms can be retreated up to two times with the same dosage regimen.

How does xifaxan make you feel? ›

Common side effects of Xifaxan

Swelling of the feet, hands, and arms (peripheral edema) Dizziness. Fatigue. Fluid retention around the abdomen (ascites): bloating, abdominal pain, weight gain.

Does rifaximin help with sleep? ›

Conclusion: Rifaximin as a treatment of overt HE is associated with decreased sleep time/24h and significant improvement in sleep quality.

Is weight gain a side effect of xifaxan? ›

Xifaxan side effects

fever; or. fluid build-up around the stomach - rapid weight gain, stomach pain and bloating, trouble breathing while lying down.

What is the best probiotic for SIBO? ›

Best probiotics for SIBO

Although it may be seen as contradictory to use probiotics in small intestinal bacterial overgrowth, one particular probiotic yeast, Saccharomyces boulardii, has been identified as beneficial.

Can I take vitamins with rifaximin? ›

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What are the side effects of rifaximin? ›

More common
  • Bloated.
  • difficulty with moving.
  • excess air or gas in the stomach or intestines.
  • frequent urge to defecate.
  • full feeling.
  • headache.
  • muscle pain or stiffness.
  • pain in the joints.
Feb 1, 2023

Is Xifaxan bad for your liver? ›

Hepatotoxicity. Despite widespread use, there is little evidence that rifaximin when given orally causes liver injury, either in the form of serum enzyme elevations or clinically apparent liver disease. Likelihood score: E (unlikely cause of clinically apparent liver injury).

Does Xifaxan reduce inflammation? ›

Our studies provide evidence that rifaximin reduces mucosal inflammation and improves gut barrier function in rats subjected to water avoidance or repeat restraint stress. These effects are accompanied by normalization of visceral hypersensitivity.

Is fatigue a side effect of Xifaxan? ›

Fatigue can occur with this medication and you may need to adjust your schedule to manage fatigue.

Does rifaximin affect kidney? ›

Rifaximin Decreases the Incidence and Severity of Acute Kidney Injury and Hepatorenal Syndrome in Cirrhosis. Dig Dis Sci.

How long does rifaximin work for SIBO? ›

How long does it take for Xifaxan to work for SIBO? Xifaxan is prescribed off-label for SIBO, so there is no set therapy for its use. Three different high-dose treatment regimens are used and usually last from seven to 14 days. Patients should experience symptom relief after completing the treatment course.

How long can rifaximin be taken for IBS? ›

Recent studies showed that treatment with rifaximin at a dose of 550 mg three times daily for 14 days provides better relief of IBS symptoms than placebo for up to 10 weeks after completion of therapy [Pimentel et al.

Who should not take XIFAXAN? ›

You should not take rifaximin if you are allergic to rifaximin, rifabutin, rifampin, or rifapentine. Tell your doctor if you have ever had: liver disease; diarrhea with a fever; or.

What is the success rate of rifaximin? ›

The response to rifaximin treatment in IBS-D patients has been shown to correlate with the normalization of the LHBT results [32, 36, 37]. In our study, 57.7% of the included patients had a positive LHBT, and 20 showed LHBT normalization after 2 weeks of rifaximin treatment, with a SIBO eradication rate of 44.4%.


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