Does rifaximin decrease small intestinal bacterial overgrowth in patients with irritable bowel syndrome?
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- Answered 21 Oct 2019 Conflict of interest declaration: None The 2017 paper “Small Intestinal Bacterial Overgrowth and Irritable Bowel Syndrome: A Bridge between Functional Organic Dichotomy”  reports: “In a recent meta-analysis, efficiency of rifaximin (two studies) in eradicating SIBO was 64.1% as compared to 41% with other systemic antibiotics (metronidazole or tetracycline, p=0.003). Another meta-analysis of eight studies showed that overall normalization rate of breath test with rifaximin was 49.5% (95% CI, 44.0 to 55.1). Antibiotics like metronidazole, neomycin and ciprofloxacin (four studies) showed higher response rate than placebo in normalizing breath tests with an odds ratio of 2.55 (95% CI, 1.29 to 5.04). Thus, evidence from above studies suggests that antibiotics can be given in IBS patients with suspected SIBO.” SIBO = small intestinal bacterial overgrowth The above passage links to two reviews [2, 3]. Another 2017 review “Systematic review with meta-analysis: rifaximin is effective and safe for the treatment of small intestine bacterial overgrowth”  concludes: “Rifaximin treatment seems to be effective and safe for the treatment of SIBO. However, the quality of the available studies is generally poor. Well-designed RCTs are needed to substantiate these findings and to establish the optimal regimen.” Finally, you may find this 2016 article “Review article: potential mechanisms of action of rifaximin in the management of irritable bowel syndrome with diarrhoea.”  interesting. References 1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5347643/ 2) https://www.ncbi.nlm.nih.gov/pubmed/24004101 3) https://www.gastrojournal.org/article/S0016-5085(13)62707-9/pdf 4) https://www.ncbi.nlm.nih.gov/pubmed/28078798 5) https://www.ncbi.nlm.nih.gov/pubmed/26618924