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ID Rounds: New Non-Absorbed Antibiotic Safe for GI Complaints

Rifaximin (Xifaxan) is a poorly absorbed derivative of rifamycin (Rifampin)... While its greatest activity is against gram-positive organisms because there is almost no absorption, very high concentrations can be safely achieved in the gut, making it effective for gram-negative and anaerobic organisms as well. The drug has potential uses for travelers' diarrhea, hepatic encephalopathy, and other gastrointestinal diseases. A review of 10 studies noted that administration three times a day for three days is superior to loperamide and at least as effective as ciprofloxacin. There is minimal potential for drug interaction or development of bacterial resistance, and the tolerability profile is…

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Articles of Interest

Rifaximin for the treatment of acute infectious diarrhea

Rifaximin is a nonabsorbable rifamycin derivative with an excellent safety profile and a broad spectrum of antimicrobial activity against a variety of enteropathogens causing acute infectious diarrhea. After oral ingestion, its bioavailability is known to be less than 0.4%, and it has a low potential for significant drug interactions. In the treatment of travelers’ diarrhea caused by noninvasive diarrheagenic Escherichia coli, it has been demonstrated that rifaximin significantly shortens the duration of diarrhea and has an efficacy similar to that of ciprofloxacin.

ARiE Trial – Rifaximin for encephalopathy

The addition of rifaximin to broad-spectrum antimicrobials does not result in early HE resolution in critically ill patients with cirrhosis and does not reduce the incidence of infection or endotoxin levels... I will continue to use lactulose as my current standard treatment for HE in critically ill patients. Where lactulose is not tolerated or HE is refractory to this therapy, I consider rifaximin as a relatively safe adjunct therapy that may improve HE resolution and recurrence, particularly in those with decompensated cirrhosis.

Rifaximin (Xifaxan) for Irritable Bowel Syndrome

Rifaximin (Xifaxan) is an oral antibiotic previously marketed for the treatment of traveler's diarrhea and hepatic encephalopathy. It is now also labeled for the treatment of irritable bowel syndrome (IBS) with diarrhea. Rifaximin has activity against anaerobic, gram-positive, and gram-negative bacteria, including Clostridium difficile. It is not systemically absorbed and is active only in the gastrointestinal tract. It may work by reducing bacterial byproducts and altering intestinal microbiota.

Rifaximin Therapy for Patients with Irritable Bowel Syndrome without Constipation

The antibiotic effect of rifaximin is the presumed mechanism for its sustained beneficial effects in patients with IBS. A response to antibiotic therapy in patients with IBS has been shown to correlate with normalization of the results of lactulose hydrogen breath tests. However, there is debate about which antibiotic-related effect is most important.

Rifaximin, a non-absorbable rifamycin, for the treatment of hepatic encephalopathy. A double-blind, randomised trial

Our findings confirm, therefore, the usefulness of rifaximin in the treatment of HE, supporting its use as a first-choice antibiotic, particularly in patients intolerant to neomycin or with impaired renal function.

Rifaximin, a Poorly Absorbed Antibiotic: Pharmacology and Clinical Potential

Although rifaximin has stood the test of time, it still attracts the attention of both basic scientists and clinicians. As a matter of fact, with the advancement of the knowledge on microbial-gut interactions in health and disease novel indications and new drug regimens are being explored. Besides widening the clinical use, the research on rifaximin is also focused on the synthesis of new derivatives and on the development of original formulations designed to expand the spectrum of its clinical use.

Rifaximin: beyond the traditional antibiotic activity

Rifaximin, polymorph α, has a broad-spectrum antibacterial activity in vitro against enteric pathogens, characterized by a gut-localized action and minimal systemic absorption. Consequently, rifaximin was developed for a variety of enteric conditions that involve a pathogenic role of bacteria. In addition to its antibacterial activity, there is some evidence that rifaximin may have other activities, including anti-inflammatory activity, alteration of bacterial virulence and prevention of bacterial translocation. Although the rifamycins were discovered by Sensi in 1957, their derivatives such as rifaximin still show new perspectives of development.

The Use of Rifaximin for IBS

There are a variety of treatment options for irritable bowel syndrome (IBS). One that is becoming more common is the use of the antibiotic, rifaximin. The purpose of this article is to simply break down why this medication is commonly used, what it does, and what to consider if choosing to take it.

The Use of Rifaximin in Patients With Cirrhosis

More than four decades ago, an association between HE and abnormalities in ammonia metabolism was observed.(1) The association between circulating unmetabolized ammonia level and HE was weak. However, because production of ammonia is closely related to the composition of gut microbiota, the idea emerged that oral administration of minimally absorbed antibiotics that were effective against ammonia‐producing bacteria could help treat or prevent HE.

Therapeutic Effects and Mechanisms of Action of Rifaximin in Gastrointestinal Diseases

Rifaximin is indicated for the treatment of travelers’ diarrhea caused by noninvasive Escherichia coli strains and also for reducing the risk of recurrence of overt hepatic encephalopathy.

Use of rifaximin in gastrointestinal and liver diseases

Rifaximin is a broad spectrum oral antibiotic with antimicrobial activity against Gram-positive and Gram-negative aerobic and anaerobic bacteria. It is poorly absorbed and thus has a highly favorable safety profile. Rifaximin has been shown to be effective in the treatment of traveler’s diarrhea, functional bloating and irritable bowel syndrome, small bowel bacterial overgrowth and in the prevention of recurrent overt hepatic encephalopathy. In addition, there is emerging evidence for a possible beneficial effect of rifaximin in the treatment of uncomplicated diverticular disease and in the prevention of recurrent diverticulitis.

Resources

StatPearls

Rifaximin is an antibiotic used to treat irritable bowel syndrome with diarrhea, reduce the risk of overt hepatic encephalopathy recurrence in adults, and treat travelers’ diarrhea caused by noninvasive strains of Escherichia coli. Rifaximin has a broad spectrum of activity against both gram-negative and gram-positive anaerobic and aerobic bacteria. This antibiotic is used primarily in diseases since it is specific to the gastrointestinal tract due to its nonabsorbable profile.

Xifaxan

XIFAXAN® (rifaximin) 550 mg tablets are indicated for the reduction in risk of overt hepatic encephalopathy (HE) recurrence in adults and for the treatment of irritable bowel syndrome with diarrhea (IBS-D) in adults.