A systematic review of the use of rifaximin for Clostridium difficile infections

Ng, Qin Xiang; Loke, Wayren; Foo, Nadine Xinhui; Mo, Yin; Yeo, Wee‐Song; Soh, Alex Yu Sen

doi:10.1016/j.anaerobe.2018.10.011

Cited by 19 publications

(12 citation statements)

References 30 publications

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“…Rifaximin has been suggested as an alternative to existing CDI therapies, especially in CDI recurrences and their prevention [ 133 , 134 ]. Data on rifampin resistance, which correlate with rifaximin [ 135 ], showed a high level of resistance in investigated C. difficile isolates (787/1861) and suggest more risk to treatment failure due to C. difficile strain resistance compared to recommended CDI treatments.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial resistance in Clostridioides (Clostridium) difficile derived from humans: a systematic review and meta-analysis

Sholeh

Krutova

Forouzesh

et al. 2020

Antimicrob Resist Infect Control

100

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Background Clostridioides (Clostridium) difficile is an important pathogen of healthcare- associated diarrhea, however, an increase in the occurrence of C. difficile infection (CDI) outside hospital settings has been reported. The accumulation of antimicrobial resistance in C. difficile can increase the risk of CDI development and/or its spread. The limited number of antimicrobials for the treatment of CDI is matter of some concern. Objectives In order to summarize the data on antimicrobial resistance to C. difficile derived from humans, a systematic review and meta-analysis were performed. Methods We searched five bibliographic databases: (MEDLINE [PubMed], Scopus, Embase, Cochrane Library and Web of Science) for studies that focused on antimicrobial susceptibility testing in C. difficile and were published between 1992 and 2019. The weighted pooled resistance (WPR) for each antimicrobial agent was calculated using a random- effects model. Results A total of 111 studies were included. The WPR for metronidazole and vancomycin was 1.0% (95% CI 0–3%) and 1% (95% CI 0–2%) for the breakpoint > 2 mg/L and 0% (95% CI 0%) for breakpoint ≥32 μg/ml. Rifampin and tigecycline had a WPRs of 37.0% (95% CI 18–58%) and 1% (95% CI 0–3%), respectively. The WPRs for the other antimicrobials were as follows: ciprofloxacin 95% (95% CI 85–100%), moxifloxacin 32% (95% CI 25–40%), clindamycin 59% (95% CI 53–65%), amoxicillin/clavulanate 0% (0–0%), piperacillin/tazobactam 0% (0–0%) and ceftriaxone 47% (95% CI 29–65%). Tetracycline had a WPR 20% (95% CI 14–27%) and meropenem showed 0% (95% CI 0–1%); resistance to fidaxomicin was reported in one isolate (0.08%). Conclusion Resistance to metronidazole, vancomycin, fidaxomicin, meropenem and piperacillin/tazobactam is reported rarely. From the alternative CDI drug treatments, tigecycline had a lower resistance rate than rifampin. The high-risk antimicrobials for CDI development showed a high level of resistance, the highest was seen in the second generation of fluoroquinolones and clindamycin; amoxicillin/clavulanate showed almost no resistance. Tetracycline resistance was present in one fifth of human clinical C. difficile isolates.

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Section: Discussionmentioning

confidence: 99%

Antimicrobial resistance in Clostridioides (Clostridium) difficile derived from humans: a systematic review and meta-analysis

Sholeh

Krutova

Forouzesh

et al. 2020

Antimicrob Resist Infect Control

100

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“…In a clinical, randomised study from 1990 with a total of 20 patients, Boero [44] found no significant difference in outcome after vancomycin or rifaximin (RR 0.90, 95% CI 0.69-1.18). In a systematic review from 2018 [45], eight studies from 2007-2017 were reviewed, including two randomised studies. One common finding was that rifaximin was used primarily as a relapse prophylaxis immediately after stopping either vancomycin or metronidazole treatment.…”

Section: Rifaximinmentioning

confidence: 99%

Danish national guideline for the treatment ofClostridioides difficileinfection and use of faecal microbiota transplantation (FMT)

Baunwall

Dahlerup

Engberg

et al. 2021

Scandinavian Journal of Gastroenterology

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Aim: This Danish national guideline describes the treatment of adult patients with Clostridioides (formerly Clostridium) difficile (CD) infection and the use of faecal microbiota transplantation (FMT). It suggests minimum standard for implementing an FMT service. Method: Four scientific societies appointed members for a working group which conducted a systematic literature review and agreed on the text and recommendations. All clinical recommendations were evalluated for evidence level and grade of recommendation. Results: In CD infection, the use of marketed and experimental antibiotics as well as microbiota-based therapies including FMT are described. An algorithm for evaluating treatment effect is suggested. The organisation of FMT, donor recruitment and screening, laboratory preparation, clinical application and follow-up are described. Conclusion: Updated evidence for the treatment of CD infection and the use of FMT is provided.

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“…26 However, the major drawbacks to its use are the propensity to select antibiotic-resistant forms of other bacteria present in the gut. 27 Additionally, like metronidazole it is not sporicidal, leaving the patient vulnerable to recurrences. 23…”

Section: Antimicrobial Treatmentmentioning

confidence: 99%

“…25 Other small open-label trials and retrospective studies found rifaximin to be comparable to standard therapies, but with highly heterogeneous study characteristics. 27 Data from ongoing trials are awaited (ClinicalTrials.gov identifier: NCT01670149).…”

Section: Treating Recurrencesmentioning

confidence: 99%

Management ofClostridioides difficilecolitis: insights for the gastroenterologist

Saha

Khanna

2019

Therap Adv Gastroenterol

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Clostridioides difficile infection (CDI) is a common cause of diarrhea in both inpatient and outpatient settings. The last few years have seen major changes in the treatment spectrum of CDI, most notably, recommendations against using metronidazole for initial CDI, the addition of fidaxomicin and bezlotoxumab, and emergence of microbial replacement therapies. Several other therapies are undergoing clinical trials. This narrative review focuses on the treatment of CDI with a summary of literature on the newer modalities and the treatment guidelines issued by Infectious Diseases Society of America and European Society of Clinical Microbiology and Infectious Diseases.

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A systematic review of the use of rifaximin for Clostridium difficile infections

Cited by 19 publications

References 30 publications

Antimicrobial resistance in Clostridioides (Clostridium) difficile derived from humans: a systematic review and meta-analysis

Antimicrobial resistance in Clostridioides (Clostridium) difficile derived from humans: a systematic review and meta-analysis

Danish national guideline for the treatment ofClostridioides difficileinfection and use of faecal microbiota transplantation (FMT)

Management ofClostridioides difficilecolitis: insights for the gastroenterologist

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