Why is this in the news and on tv now? (Rifaxamin/Xifaxin)
#358588 - 05/13/10 05:13 AM
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Indicates that (only) 40% of ibs-d patients have significant improvement - some totally recover:
http://wcbstv.com/topstories/irritable.bowel.cure.2.1690684.html
Cheers.
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ibs-d (pseudo)with pain and bloating
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This news article doesn't appear to report anything that has not been reported in the news over the past few years. Pimental and SIBO have in the news on and off for a few years. He is the one who proposed the use of the lactulose breath test to determining SIBO and the use of non-absorbable antibiotics such as Rifaximin (Xifaxin) for treatment.
Recently there have been a series of article that question the reliability of the test to distinguish SIBO individuals from controls. Frequently after treatment with antibiotics the IBS symptoms return again. There have been a number of people on the board who have tried Rifaxamin with short term or poor results. I don't recall see anyone post with long term positive results using this antibiotic. 
SIBO, its relationship to IBS and treatment with antibiotics is still a questionable approach requiring more investigation. It may be helpful to some but it does not appear to be as useful a therapeutic approach for managing IBS as originally thought.
Reference
Vanner, S. The lactulose breath test for diagnosing SIBO in IBS patients: another nail in the coffin . The American Journal Of Gastroenterology 103, 964-965 (2008).
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Salix Announces FDA Acceptance for Filing and Priority Review Designation For XIFAXAN550 sNDA For the Treatment of Non-Constipation Irritable Bowel Syndrome
PDUFA Action Date Designated as December 7, 2010:
http://www.marketwatch.com/story/salix-announces-fda-acceptance-for-filing-and-priority-review-designation-for-xifaxan550-snda-for-the-treatment-of-non-constipation-irritable-bowel-syndrome-2010-08-09?reflink=MW_news_stmp
Is this a new higher dosage of Rifaximin (550 mg)? Is it to be taken 1, 2 or 3 times a day? Is it to be taken once or periodically?
Cheers.
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ibs-d (pseudo)with pain and bloating
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Re: XIFAXAN550
#360310 - 08/14/10 08:58 AM
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Syl
Reged: 03/13/05
Posts: 5499
Loc: SK, CANADA
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In this study Small intestine bacterial overgrowth and irritable bowel syndrome-related symptoms: experience with Rifaximin the dose used was 1200 mg per day for 7 days which suggests that 550 mg twice a day might be the dose that is used. There have been other studies that used 800 mg per day for 10 days and 1200 mg per day for 10 days.
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STABLE: ♂, IBS-D 50+ years - Science of IBS
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Apparently the FDA believes in the efficacy of Rifaximin at this dosage and this frequency(?).
What (new?) evidence is this based upon?
The FDA has given wrong approval sometimes in the past.
Cheers.
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ibs-d (pseudo)with pain and bloating
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Re: XIFAXAN550
#360312 - 08/14/10 09:42 AM
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Syl
Reged: 03/13/05
Posts: 5499
Loc: SK, CANADA
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Only an application has been made. The FDA hasn't approved it yet so we don't know what they think.  However, they have previously approved its use for Hepatic Encephalopathy
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STABLE: ♂, IBS-D 50+ years - Science of IBS
The FODMAP Approach to Managing IBS Symptoms
Evidence-based Dietary Management of Functional GI Symptoms: The FODMAP Approach
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Seems like a strange result:
Clinical trial: the combination of rifaximin with partially hydrolysed guar gum is more effective than rifaximin alone in eradicating small intestinal bacterial overgrowth
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2010.04436.x/abstract
Cheers.
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ibs-d (pseudo)with pain and bloating
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This research uses an interesting idea. The authors reason that PHGG as a prebiotic SF works as follows
"Thus, we have hypothesized that adding a prebiotic such as partially hydrolysed guar gum (PHGG) to rifaximin can be of help in the decontamination of small bowel. In fact, it can have a beneficial effect on intestinal motility and therefore a synergic interaction between rifaximin and PHGG may lead to a higher eradication rate of SIBO. The primary end point of our study was to assess whether the combination of rifaximin with PHGG is more effective than Rifaximin alone in eradicating SIBO, whereas the secondary end point was to evaluate whether the combined treatment obtains a greater symptomatic improvement than rifaximin alone."
PHGG is know to increase colonic concentration of Lactobacilli and Bifidobacteria. The PHGG a prebiotic SF may improve intestinal motility and have a prebiotic effect that promotes the growth of natural colon flora. They conclude "Therefore, the prebiotic effect of PHGG is likely to provide a synergistic action with rifaximin inside the bowel lumen, by improving intestinal clearance and favouring the microflora balance."
It will be interesting to see if this idea gains traction in clinical practice.
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STABLE: ♂, IBS-D 50+ years - Science of IBS
The FODMAP Approach to Managing IBS Symptoms
Evidence-based Dietary Management of Functional GI Symptoms: The FODMAP Approach
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Apparently Benefiber changed from phgg to inulin to wheat dextrin but the phgg benefiber is still available:
http://www.planetrx.com/shop/detail.cfm?sku=au248&utm_source=frg&utm_medium=feed&utm_campaign=product&zmam=1000941&zmas=26&zmac=106&zmap=au248
Is there a downside to phgg?
Cheers.
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ibs-d (pseudo)with pain and bloating
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I have not heard of any problems. It is found in many processed foods as a thickener. In Canada Benefibre is still made with inulin. I have no idea why they don't use the wheat dextrin formulation used in the US and UK. I suspect they choose PHGG for the Rifaximin study because it has been used in many other studies.
I don't believe that PHGG would be the only SF that might show a benefit when used with Rifaximin for controlling SIBO. I suspect that any SF with good prebiotic effects might work just as well.
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STABLE: ♂, IBS-D 50+ years - Science of IBS
The FODMAP Approach to Managing IBS Symptoms
Evidence-based Dietary Management of Functional GI Symptoms: The FODMAP Approach
FODMAP Chart & Cheatsheet
The Role of Food & Dietary Intervention in IBS
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