# Rifaximin Dose-Finding Study for the Treatment of Small Intestinal



## eric (Jul 8, 1999)

Rifaximin Dose-Finding Study for the Treatment of Small Intestinal Bacterial OvergrowthPosted 07/12/2005E.C. Lauritano; M. Gabrielli; A. Lupascu; A. Santoliquido; G. Nucera; E. Scarpellini; F. Vincenti; G. Cammarota; R. Flore; P. Pola; G. Gasbarrini; A. Gasbarrini Summary and IntroductionSummaryBackground: Few controlled studies assessing choice and duration of antibiotic therapy for small intestinal bacterial overgrowth are available.Aim: To assess efficacy, safety and tolerability of different doses of rifaximin, a broad spectrum non-absorbable antibiotic, for intestinal bacterial overgrowth eradication.Methods: We enrolled 90 consecutive patients affected by small intestinal bacterial overgrowth. The presence of small intestinal bacterial overgrowth was based on the occurrence of a rise of H2 values >12 p.p.m. above the basal value after 50 g glucose ingestion. Patients were randomized in three 7-day treatment groups: rifaximin 600 mg/day (group 1); rifaximin 800 mg/day (group 2) and rifaximin 1200 mg/day (group 3). Glucose breath test was reassessed 1 month after the end of therapy. Compliance to the treatment and incidence of side-effects were also evaluated.Results: No drop-outs were observed in the three groups. Glucose breath test normalization rate was significantly higher in group 3 (60%) with respect to group 1 (17%; P < 0.001) and group 2 (27%, P < 0.01). No significant differences in patient compliance and incidence of side-effects were found among groups.Conclusions: Higher doses of rifaximin lead to a significant gain in terms of therapeutic efficacy in small intestinal bacterial overgrowth eradication without increasing the incidence of side-effects.IntroductionSmall intestinal bacterial overgrowth (SIBO) is a clinical condition characterized by a malabsorption syndrome because of an increase in micro-organisms to a level exceeding 105 bacteria/mL of jejunal juice.[1] Glucose breath test (GBT) has been proposed as a sensitive and simple tool for the diagnosis of bacterial overgrowth, being non-invasive and inexpensive compared with the gold standard, which is represented by the culture of intestinal aspirates; specificity and sensitivity of GBT are acceptable for screening studies (77-100% and 67-98% respectively).[2-4] The H2 and CH4 produced in the human body after glucose ingestion derive entirely from intestinal bacterial fermentation, therefore the appearance of an early increase in breath H2 or CH4 concentration indicates the presence of a small bowel bacterial overgrowth.[2-4]Antibiotic therapy is the cornerstone of the treatment of SIBO. Current SIBO treatment is based on empirical courses of broad spectrum antibiotics as few controlled studies with respect to choice and duration of antibiotic therapy exist at present.[1]A remarkable improvement in symptoms can be achieved in most patients.[1] Overgrowth may occur either by a mix of aerobic and anaerobic flora or by purely aerobic flora. Therefore, the most effective antibiotic regimens generally include one or more drugs with activity against aerobic and anaerobic bacteria.[1]Rifaximin is a rifamycin derivative with antibacterial activity caused by inhibition of bacterial synthesis of RNA.[5] It is active against Gram-positive and Gram-negative bacteria, including both aerobes and anaerobes.[6] Less than 0.1% of the oral dose of rifaximin is absorbed.[6] Rifaximin is available in Italy for the treatment of acute bacterial diarrhoea,[7] portosystemic encephalopathy[8] and small bowel bacterial overgrowth syndrome,[9] and it is also licensed in many countries of Europe and other continents.The aim of the present study was to assess the efficacy as well as safety and tolerability of different doses of rifaximin for the treatment of SIBO. Next Page: Methods http://www.medscape.com/viewarticle/507463


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## SpAsMaN* (May 11, 2002)

Wow bump


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## flux (Dec 13, 1998)

Pimental talked about this paper in his presentation.


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