Efficacy of rifaximin in treating with small intestine bacterial overgrowth: a systematic review and meta-analysis

Wang, Jinsheng; Zhang, Lei; Hou, Xiaohua

doi:10.1080/17474124.2021.2005579

Cited by 20 publications

(7 citation statements)

References 43 publications

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“…Recently, rifaximin has been increasingly used in the treatment of SIBO [ 34 , 35 ]. Rifaximin has a good safety profile, is not absorbed from the gastrointestinal tract, dissolves well in bile, has broad-spectrum antibacterial effects against Gram-positive and Gram-negative aerobic and anaerobic bacteria, and its side effects are comparable with those of a placebo.…”

Section: Sibo Treatmentmentioning

confidence: 99%

“…Another valuable characteristic of rifaximin is the fact that it does not produce bacterial resistance, and therefore, can be used again (provided the necessary interval of at least four weeks is maintained between consecutive 14-day courses of rifaximin treatment) [ 37 ]. Two recent meta-analyses assessing the safety and efficacy of rifaximin in the treatment of SIBO demonstrated high rates of successful eradication (71% and approximately 60% in the meta-analyses from 2017 and from 2021, respectively) [ 34 , 35 ].…”

Section: Sibo Treatmentmentioning

confidence: 99%

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How to Recognize and Treat Small Intestinal Bacterial Overgrowth?

Skrzydło-Radomańska

Cukrowská

2022

JCM

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Small Intestinal Bacterial Overgrowth (SIBO) is a form of dysbiosis that involves increased bacterial colonization of the small intestine with some of the bacteria more characteristic of the colon microbiota. The prevalence of SIBO over recent decades has been estimated to range from 2.5 to 22% (depending on the source) and to increase with age and among individuals with comorbidities. Recently, an increase in the number of diagnosed SIBO cases has been observed, which is primarily due to the availability of noninvasive breath tests that facilitate the diagnostic process. However, SIBO is still both a diagnostic and a therapeutic problem. This review presents the pathophysiology, manifestations, diagnostics, and recommended management of SIBO.

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Section: Sibo Treatmentmentioning

confidence: 99%

Section: Sibo Treatmentmentioning

confidence: 99%

How to Recognize and Treat Small Intestinal Bacterial Overgrowth?

Skrzydło-Radomańska

Cukrowská

2022

JCM

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“…Rifaximin, nonabsorbable antibiotic (550 mg 3 times a day for 14 days), has the most data for use in treatment of SIBO ( 76 , 77 ). Significant benefits of rifaximin are that it is generally well tolerated and repeated administrations appear to have a low risk of microbial resistance ( 78 ).…”

Section: Methodsmentioning

confidence: 99%

Understanding Our Tests: Hydrogen-Methane Breath Testing to Diagnose Small Intestinal Bacterial Overgrowth

Tansel

Levinthal

2023

Clin Transl Gastroenterol

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There is increasing appreciation that small intestinal bacterial overgrowth (SIBO) drives many common gastrointestinal symptoms, including diarrhea, bloating, and abdominal pain. Breath testing via measurement of exhaled hydrogen and methane gases following ingestion of a readily metabolized carbohydrate has become an important noninvasive testing paradigm to help diagnose SIBO. However, because of a number of physiological and technical considerations, how and when to use breath testing in the diagnosis of SIBO remains a nuanced clinical decision. This narrative review provides a comprehensive overview of breath testing paradigms including the indications for testing, how to administer the test, and how patient factors influence breath testing results. We also explore the performance characteristics of breath testing (sensitivity, specificity, positive and negative predictive values, likelihood ratios, and diagnostic odds ratio). Additionally, we describe complementary and alternative tests for diagnosing SIBO. We discuss applications of breath testing for research. Current estimates of SIBO prevalence among commonly encountered high-risk populations are reviewed to provide pretest probability estimates under a variety of clinical situations. Finally, we discuss how to integrate breath test performance characteristics into clinical care decisions using clinical predictors and the Fagan nomogram.

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“…When intestinal bacteria are cultured under sub-MIC rifaximin concentrations, they all exhibit a tendency toward drug resistance [ 26 ]. In a clinical study, the efficacy of rifaximin in treating small intestine bacterial overgrowth also showed dose-dependent efficacy [ 27 ]. Thus, the dose and application strategy of rifaximin will impact the effective drug concentration within the intestinal environment and further influence the inhibitory effect on ammonia-producing bacteria and their drug resistance, which deserves attention.…”

Section: Introductionmentioning

confidence: 99%

Preventive and therapeutic effects of rifaximin on hepatic encephalopathy with differential application dosages and strategies: a network meta-analysis

Fang,

Liu,

Liu

2024

BMC Gastroenterol

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Background Hepatic encephalopathy (HE) is a neuropsychiatric syndrome that affects the prognosis of patients with liver disease and is considered an independent risk factor for hospitalization and death. Rifaximin has been approved for HE treatment. This review will analyze the effect of rifaximin on different stages of HE with differential application dosages and strategies by traditional and network meta-analyses. Methods We performed a systematic search of PubMed, EmBase, and Cochrane Library databases up to February 26, 2023, to identify randomized controlled trials (RCTs) about rifaximin for the prevention and treatment of HE. The outcomes included incidence of HE and HE progression, HE reversal, mortality, and adverse effects. Results A total of 21 studies were included. In the primary prevention of HE, rifaximin significantly reduced the incidence of HE (OR: 0.66; 95% CI: 0.45, 0.96; p = 0.032). In secondary prevention, rifaximin significantly reduced the risk of recurrence in patients who were in remission (OR: 0.38; 95% CI: 0.28, 0.52; p < 0.001). In the treatment of minimal HE, rifaximin significantly reduced the breakthrough of MHE to OHE (OR: 0.17; 95% CI: 0.04,0.63; p = 0.008). Rifaximin also significantly improved the clinical symptoms of MHE and OHE patients (OR: 3.76; 95% CI: 2.69, 5.25; p < 0.001). However, rifaximin did not reduce mortality at any stage in HE patients (OR: 0.79; 95% CI: 0.58, 1.08; p = 0.133). Additionally, rifaximin did not increase the risk of adverse effects (OR: 0.96; 95% CI: 0.74, 1.24; p = 0.749). In the network meta-analysis, the 400 mg T.I.D. intervention had a relative advantage for HE risks in primary and secondary prevention. In the treatment of MHE, 600 mg b.i.d. was superior in preventing the breakthrough from MHE to OHE. Conclusion Rifaximin prevented HE risks and progression and improved clinical symptoms in patients with MHE but did not reduce mortality. For primary and secondary prevention, 400 mg t.i.d. could be considered. 600 mg b.i.d. could be considered in patients with MHE.

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Efficacy of rifaximin in treating with small intestine bacterial overgrowth: a systematic review and meta-analysis

Cited by 20 publications

References 43 publications

How to Recognize and Treat Small Intestinal Bacterial Overgrowth?

How to Recognize and Treat Small Intestinal Bacterial Overgrowth?

Understanding Our Tests: Hydrogen-Methane Breath Testing to Diagnose Small Intestinal Bacterial Overgrowth

Preventive and therapeutic effects of rifaximin on hepatic encephalopathy with differential application dosages and strategies: a network meta-analysis

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