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Antibiotic Rifaximin Appears Safe and Effective for Irritable Bowel Syndrome
      10/26/06 10:29 AM
HeatherAdministrator

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Rifaximin Appears Safe and Effective for Irritable Bowel Syndrome

NEW YORK (Reuters Health) Oct 16 - Treatment with the nonabsorbed oral antibiotic rifaximin for 10 days can improve the symptoms of irritable bowel syndrome (IBS) for up to 10 weeks, findings from a small study suggest.

Previous reports have suggested that alterations in gut flora, primarily bacterial overgrowth, may influence the pathogenesis of irritable bowel syndrome. Therefore, treatment with agents that modify this flora might have an effect on disease outcomes, Dr. Mark Pimentel, from the Cedars-Sinai Medical Center in Los Angeles, and colleagues note in the Annals of Internal Medicine for October 17.

Neomycin therapy has proven useful in reducing IBS symptoms, but the bacterial overgrowth elimination rate is just 25%. By contrast, rifaximin, which has broad-spectrum activity, has been shown to achieve rates as high as 70%.

The present study involved 87 patients with IBS who were randomized to receive rifaximin 400 mg or placebo three times daily for 10 days. In addition to completing IBS-related questionnaires before and 7 days after treatment, the subjects kept weekly symptom diaries for 10 weeks.

Patients treated with rifaximin experienced significantly greater improvements in IBS symptoms than did controls (p = 0.02). This primarily related to a drop in bloating as no major differences were noted between the groups in abdominal pain, diarrhea, or constipation.

Rifaximin was generally well tolerated and was associated with only rare, minor side effects that occurred with similar frequency in the control group.

"The clinical challenge is to identify the subset of patients with IBS who are most likely to have bacterial overgrowth that produces symptoms relative to the many other factors contributing to patients' clinical state," Dr. Douglas A. Drossman, from the University of North Carolina at Chapel Hill, comments in a related editorial.

"Pimentel and colleagues should be congratulated for their efforts to increase awareness of this important subgroup of patients with IBS symptoms who need to be identified and treated. However, until better evidence is available, decisions relating to diagnosis and treatment remain within the art of medicine," he adds.

Ann Intern Med 2006;145:557-563,626-628.


http://www.medscape.com/viewarticle/546127

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